Tech Tip: Pontics

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It is not unusual for a patient undergoing orthodontic treatment with clear aligners to have one or more missing teeth. One of the unique features of treating with aligners is the opportunity for the doctor to provide a virtual pontic to fill in the missing space.

Definition

pontic is defined as an artificial tooth on a fixed dental prosthesis that replaces a missing natural tooth, restoring its function and esthetics. It usually fills the space previously occupied by the clinical crown of the missing tooth.

virtual pontic is a tooth-shaped placeholder in an aligner created in the space left by missing teeth. Since the aligner does not cover a tooth in this location, there is a resulting void in the aligner. Fortunately, this void can be painted or filled to create the appearance of a tooth in that space.

For larger spaces in the posterior areas, a bar is often added to improve structural integrity, instead of a tooth-shaped void.

You can request a virtual pontic at the time of case submission, in the "Additional Instructions" section. The technician will need to know whether you want the space filled by the pontic to close as the teeth move, or be maintained for future restoration.

Pontics are represented on treatment setups as translucent teeth.

Pontic Techniques

A virtual pontic can be left as an empty void in the aligner, but if you want it to look more like a tooth, there are two main techniques to choose from:

Pontic aligner paint

The inside of the void can be coated with pontic aligner paint (such as Perfect-A-Smile,available in the ClearCorrect Store). This light cure paste comes in varying colors which can be mixed to approximate the shade of adjacent teeth and applied by the doctor or staff prior to delivery of the aligners. This technique is only necessary while the space resembles the shape of a tooth.

Instructions for applying Perfect-A-Smile are available in PDF and video formats.

PVS adhesive material

Instead of painting the inside of the plastic aligner, the pontic void can be filled with a tooth-shaded, vinyl polysiloxane (PVS) adhesive material. While this technique can look good, the material is prone to falling out of the aligners.

We hope you found this information helpful! You can find more like this in our Help Center.

Until next time…

ClearCorrect Dream Team at Siroworld

Drs. Barsoum, Fischer, and Gardell talk about CEREC scanners and clear aligners.

“We’d all like to extend the message to the patients that dentistry has changed. It’s the not the same old stuff they used to be afraid of in the past. The future holds a lot more positive restorations, smiles, teeth straightening – come and get it!” - Dr. Ken Fischer

 

New treatment setups & treatment planning

Reviewing and approving the treatment setup for your patient is one of the key factors in planning treatment. This is where you get to map out the treatment outcomes desired by you and your patient.

ClearCorrect's role is to help you create the treatment setup you want for your patient. We can offer recommendations for the course of treatment, but those recommendations are not absolute. It's up to you to make any necessary changes to customize an ideal treatment plan for each individual patient.

Browser-based treatment setups are here

From now on, treatment setups for new cases will be displayed as a web page, instead of as a file in Adobe Reader. This reduces crashes, works on mobile devices, and lays the groundwork for future improvements. Tooth charts are missing right now, but we expect to add them soon. You’ll still need Adobe Reader to view setups that were created before this release.

If you have any trouble, first make sure your browser is up to date and then let us know at support@clearcorrect.com.

Viewing and approving the treatment setup

A treatment setup contains 3D models for each step of the treatment, representing the tooth movements that you prescribe. If you approve the setup, these models will be printed and used to manufacture the aligners.

Treatment setups appear in the case list on dr.clearcorrect.com when they're ready for your review.

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Click a case in the list to visit its case page. You'll find the treatment setup near the top. Click the treatment setup icon and your setup will open in a web browser window. New web-based setups should work in current versions of Internet Explorer, Chrome, Safari, and Firefox for Mac, Windows, iOS, and Android.

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A link to a shareable version, which hides the patient's first name and evaluation button is also available for new setups. Click "Share link" and copy the URL that is displayed. This can be pasted into an email or text message for sharing with patients or colleagues.

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Evaluating the treatment setup

You’ll want to start by confirming the accuracy of the model and bite articulation. Put the timeline in the starting position and tilt the model up to check for gaps between the upper and lower incisors—this often indicates an improper bite.

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From the front, check the midline relationship. Use the right and left views to verify the overjet, overbite, canine, and molar relationships. Use the occlusal views to confirm that the impressions or intraoral scans accurately captured the shape of the teeth.

If you’re satisfied with the starting model, carefully review the subsequent steps to verify that the planned tooth movements are safe and effective.Verify that any recommended IPR and engagers are sufficient to achieve your goals.

Bear in mind that these models really represent the shape of the aligners that you will be given—no one can guarantee what the teeth will do in real life. ClearCorrect’s technicians will attempt to follow your instructions as closely as possible. As the prescribing doctor, you are ultimately responsible for your patient’s orthodontic care.

When you’re done reviewing the setup, click EVALUATE to return to the case page.

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If you're happy with the treatment as shown, click APPROVE to accept it and pay for the case, then click SUBMIT. When we get your approval, we'll start manufacturing the sequence of aligners represented in the treatment setup.

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Declining the treatment setup

If the model looks inaccurate, you want to move the teeth differently, or you want to cancel the case, click DISAPPROVE 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 for your approval within a few days.

This also is where we can adjust any of your preferences related to IPR (which teeth, when and how, no IPR, expansion, limited IPR, limited expansion, etc.) or engagers based on your specifications.

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You will receive an email notification once your revised treatment setup is ready to be viewed, either right away, at the end of the day, or at the end of the week, depending on often how you've asked to receive notifications.

Consider the treatment plan when submitting your case

The ideal time to look at your treatment goals is when you're submitting your case. Beginning with the end in mind is the best way to get the treatment plan you want for your patient.

Submitting more information leads to receiving better treatment setups. Our technicians are good, but they're even better with your input. We will work with you to get the treatment plan you desire.

Anticipating potential problems pre-treatment setup and deciding what approach you want to take, is also something to consider when submitting your case. Here are some common problems to consider when reviewing your setup:

Specific instructions to address any of the above problems can be given in the Additional Instructions sections when submitting a case.

We hope this information helps you submit & evaluate your future cases!

Until next time...

Coming soon: treatment setups in your browser

We’re rolling out a change next week—instead of downloading a treatment setup and viewing it in Adobe Reader, you’ll be able to view setups directly in your web browser, without any plugins or additional software. Changes you might notice include:

  • Support for mobile devices—approve your setups any time, anywhere.
  • A link to a shareable version, which hides the patient's first name and evaluation button.
  • Crisper, more responsive 3D graphics.
  • No more crashes caused by Adobe Reader updates.

You won’t need to do anything different—you’ll still click the same icon to view setups on the case pages, and approve or decline them like you do today. The setup should work in the current version of Internet Explorer, Chrome, Safari, and Firefox. If you're not sure whether your browser is up to date, you can verify that here.

Tech Tip: Extruding with auxiliaries

To create an aesthetically aligned smile, sometimes teeth need to be pulled in line with the other teeth.

Extruding teeth with auxiliaries (elastics, buttons, etc.) is a technique used to extrude a tooth that has not erupted as desired.  As always, the patient must wear the aligner (and elastic) for a minimum of 22 hours each day, or the process will not work. Watch for extrusions not occuring with your cases, as this can be one of the reasons a patient's treatment has gone off track.

How to...

Below are step by step instructions on how to extrude teeth with auxiliaries.

Download a printable guide here.

Parts needed:

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Instructions:

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Using a coarse sandpaper disc, roughen enough area on the tray to place an orthodontic bracket on the facial gingival 1/3 of the tooth to be extruded.

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You can see the relative size of the roughened area circled here in green.

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Prepare a 50/50 mixture of resin cement base and catalyst and place a small amount onto the ceramic bracket.

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Place the ceramic bracket on the roughed-out area of the aligner tray. Adjust as needed, then wait 2-3 minutes for the resin cement to set.

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Using a coarse football diamond bur, start at the top of the tray on the lingual side and cut a space to clear the bracket, leaving room for the tooth to extrude.

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Once the tray is cut, it should look something like this.

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Remove the engager from the tooth to be extruded.

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Etch the tooth to be extruded on the lingual side.

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Rinse the acid and dry with the air/water syringe.

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Bond the metal bracket with a composite resin recommended for bonding orthodontic brackets.

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Break contact on the mesial side of the tooth being extruded using a metal diamond strip, then break contact on the distal side the same way.

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Insert tray and place the elastic over the facial bracket (on the tray) and the lingual bracket (on the tooth).

Check out our Troubleshooting section in the Help Center for more helpful troubleshooting techniques to use in clear aligner treatment.

Until next time...

Tech Tip: All about checkups & revisions

We sent out a survey recently asking doctors for their questions about monitoring treatment, checkups & revisions.

In this week's tip, we've consulted with our new Clinical Advisor, Dr. Ken Fischer, to get answers to some of your questions. Dr. Fischer has over 40 years of orthodontic experience with 16 years of experience with clear aligners.

Monitoring treatment

What would you present as a "checklist" of what to look for at each checkup appointment with and without aligners in the patient's mouth? For example (but not limited to), Compliance Checkpoints.
  1. Visually confirm that the aligners are fitting completely, i.e. no incisal gaps or space between the tooth and the aligner.
  2. Confirm that patient is wearing the correct aligners.
  3. Watch patient remove the aligners; removal should be easily done without difficulty.
  4. Examine the condition of the aligners; "pristine" condition may suggest lack of wear.
  5. Use floss to confirm loose interproximal contacts between all teeth, especially at any Compliance Checkpoints. Address any tight contacts found.
  6. Evaluate the presence and condition of previously placed engagers.
  7. Confirm good fit of next aligners and patient’s ease in placing them.
  8. Refer to treatment plan paper work or treatment setups and perform any scheduled procedures, i.e. IPR, place or remove engagers, compliance checkpoints, etc.
  9. Confirm proper wear schedule and document dates to change aligners.
  10. If desired, verify that tooth movements have occurred by referring to the treatment setup.
  11. Look for blanching of the gingiva at the trim line. Blanching is occasionally seen around gingival frenum and may also be due to distortions in the impression. Often these are very minor and can be trimmed back with scissors.
  12. Some clinicians may find it helpful to run a finger along the aligner trim line to feel for sharp edges or areas where it has lifted away from the gingiva.
What are some of the key indicators that a patient is ready to move to the next aligner?
  • Full and complete fit of current aligners
  • Patient able to easily remove and place current set of aligners
  • Loose contacts and spaces closed at compliance checkpoints
  • Planned tooth movements have occurred
When I check in with the patient and if something is off or a gap is not closed, I have been told to just continue the trays. Why should I check if there isn't anything to do about it?

In most cases, minor gaps or incomplete movements can be resolved by extending the wear of the current aligners, but it is important to determine why the teeth are not tracking completely. If the clinician determines non-tracking is due to patient non-compliance, there may be a need for alternative measures such as backtracking. With backtracking, it is recommended you have the original steps remade by the lab.

In some cases, where IPR has previously been done, I don't see space closure. I continue with the trays and eventually things seem to iron themselves out. Should I be holding the patient in a current tray until that spacing closes? In general, should I be referring back to the treatment setup to compare where the patient's teeth are for each step?

Yes, holding the patient in the current aligner until a compliance checkpoint is satisfied, is good protocol. Referring to the treatment plan or setup is appropriate to confirm the need for a compliance checkpoint and to determine if the planned tooth movements have occurred. However, it is not a requirement to evaluate the position of the teeth at each step.

What is the best way to determine if the set of aligners has accomplished its goal? Sometimes when the next set of aligners is inserted, the insertion is difficult and the fit seems very, very tight and almost painful for the patient. How do you determine if the appliance has done its job, or if the arch is ready for the next appliance?

A sign that the aligner has "...done it's job..." can be if there is unquestionable good fit of the current aligner. However, even if aligners appear to fit properly and comfortably, that doesn't guarantee that the teeth are actually moving as intended. For suggestions on how to identify unseen tracking issues before treatment goes off track, see our article on Tracking Issues. A tight fit of the next aligner may very well be due to a considerable amount of tooth movement programmed for the next stage.

I have difficulty with knowing for sure on claims from patients that they are wearing their aligners the proper amount of time are true or not, do you have any suggestions?

Do not be too eager to sternly criticize or debate the patient’s claims that they are wearing their aligners as directed, but remind them that if the aligners do not fit as expected the most likely reason is lack of wear. If you continue to see signs from appointment to appointment that the aligners are not fitting well, motivation tactics should be applied. Also, check out our article on non-compliant patients which has some common signs for determining if your patient has been wearing their aligner properly.

Does the position of the engagers need to be adjusted as the teeth move?

Only if the aligners are not tracking or if a revision is requested.

Do some patients have more of an open bite with aligners than others?

Some patients exercising heavy masseter muscle activity may experience a slight post-treatment open bite due to the intrusion of the posterior teeth by the strong clenching of those teeth. This phenomenon resolves itself by removing the posterior sections of the last aligners for a few weeks to allow the intruded teeth to return to occlusion.

Please explain the "C chain", when it's indicated and what it does. Does it help when contacts of anterior teeth are not tight at the end of treatment?

The term "virtual C chain" (aka digital power chain) was originally used with brackets meaning a piece of elastic that wraps around metal braces and pulls the teeth closer together. In clear aligners, a digital power chain is not an actual, physical entity. It is a concept attained by the technician setting the teeth in tight, or even slightlyovercorrected, contact intended to close all spaces between the teeth.

Tracking and fitting

Does treatment need to track exactly as laid out in the treatment setup that I approved?

Yes, precise tracking is very important for a successful treatment result, otherwise, a revision will likely be required.

I have difficulty judging when a tooth is not tracking and when to intervene. How do you know if you case is not tracking?

The accepted definition for "not tracking" is when the teeth do not fit well in the aligners.

Example; in molar uprighting, when the aligner is not tracking, what I have done is allowed the other steps to continue to move the anterior and biscuspids, and have the patient try to "seat" the aligners around the uncooperating molars. THEN, I eventually take NEW impressions, and revise the prescription (and prolong the case) to go back and "capture" and engage the molars. So, 1) should I just request engagers on all molars that require bodily movement, and 2) what may be the reason for the original aligners not engaging the molars? (i.e., the attempted movements are TOO BIG, in micros for the aligner to fully engage the molar, or is it something else?)

A horizontal rectangular engager should always be placed on the mesiobuccal cusp for molar uprighting in order to improve the aligner’s ability to control this difficult movement. Once one recognizes that the molar is not tracking and fitting properly, do not continue with subsequent aligners; the poor fit around the molars may cause the aligners to not fit other teeth well, diminishing their effectiveness to complete staged movements.

I have difficulty with knowing when to change the course of treatment if you feel things are not tracking as they are supposed to. Is there a time or point in treatment that is "better" or "ideal" to change the course of treatment?

When the clinician observes poor tracking on two consecutive appointments, it is time to think about a revision; and begin to implement corrective measures.

Revisions

Please clarify what is considered a revision vs. mid-course correction.

ClearCorrect refers to any change to a treatment plan defined by a subsequent setup as a "revision"; this change can occur during treatment or at the end of it. The competitor in the past offered a "mid-course correction" for any change to a treatment plan defined by a subsequent setup if that change was made during treatment. Effectively, there is no actual difference in the two procedures.

Do I have to remove engagers and start over or can the engagers be left in place?

It is a best practice to remove existing engagers prior to taking a new impression or scan for a revision, and ClearCorrect requires it.

Do we always get all the trays at once when we do a revision?

Revision trays will be sent in groups of up to 12, just like they were delivered originally.

Is it considered a revision if the patient simply did not achieve the original treatment goals?

It is considered a revision if additional aligners are ordered to complete unfinished treatment goals.

Would it be better to back up a couple of steps and try to "recapture" the planned treatment before doing a revision?

If the aligners have not been tracking, backtracking may work, but if the aligners have been fitting properly, a revision would likely be necessary to finish treatment.

Is a new impression always necessary for a revision?

A revision can be based on existing models that fit well, on new impressions, or on new intraoral scans. See our article on revisions for more information on this topic.

Usually on a revision the patient wants some fine tuning. Rotations of a few degrees for example. Should I continue with a revision or place brackets on the patient to finish? It seems to me minor rotations are infrequently accomplished with revisions. Should I be placing engagers on those teeth?

While placement of brackets is an additional cost to the doctor and unpleasant for the patient, they can be used. However, complete rotation can be accomplished by:

Tips & tricks

Some of our providers offered a few tips & tricks for monitoring treatment, checkups & revisions. 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.

  • To monitor treatment, when performing checkups, I most often open the patient’s online case and just look at where the computer says the tooth position and bite are designed to be at that stage and then compare.
  • I constantly compare the patient’s progress with the treatment setup.
  • Watch the velocity of movements. If movements are too quick for extrusion, rotation, then it most likely might not happen clinically.
  • I have learned for the most part to not give multiple aligners to patients. I think it’s extremely important to be able to monitor on a regular basis.
  • If just 1 or 2 teeth, I try to dimple and window first. Need hand stripping to assure space to move.
  • I have learned to ask for overcorrection in my original prescriptions.

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: Patient compliance & wear schedules

It's been a while since we've talked about patient compliance and since it's on the top of the list for causing trouble in clear aligner treatment, we thought we'd offer a refresh and an expert opinion on the topic.

We consulted our Clinical Advisor, Dr. Ken Fischer, and here's what he had to say:

What is your experience with patient compliance and how has it affected your success or lack of success with clear aligner treatment?

Patient compliance, or wearing the removable aligners as instructed by the doctor, is absolutely critical in successful outcomes. Not every patient is going to be 100% compliant and wear their aligners 22 hours per day, every day, as we would like them to do. The Doctor's challenge is to learn and understand how each individual can best be motivated to maximize their compliance. Some patients can be "directed", others will need to be "pushed", but either way, full compliance is necessary to accomplish the treatment goal.

What is your percent of compliant vs. non-compliant patients?

Without considering the variance in the degrees of compliance, I think anywhere from 60%-75% of aligner patients are reasonably compliant and are willing to do what it takes to get the desired results. The other 25%-40% do not have the self-discipline necessary to be good, compliant aligner patients. Patient compliance is an issue that must be dealt with commonly in the practice on a daily basis, but that does not mean that we have to struggle with most patients at each appointment.

How do you manage patient compliance? What are your tips and recommendations for gaining patient compliance?

The key is to learn what is the best "motivator" or "incentive" for each patient; younger, adolescent patients will be motivated by techniques or stimulators different than those appealing to adult patients. The common denominator is for the patient to understand that they cannot complete their treatment unless they wear the aligners as directed. This means understanding the variables, that they will either have to stop treatment with an incomplete result, wasting the fee they paid, or finish with an outcome we can all be proud of. When we present the alternative treatment with braces, the patient will usually appreciate the importance of compliance.

See our article on non-compliant patients and compliance checkpoints for more information, tips and tricks on the topic of patient compliance.

Patient wear schedules

The wear schedule you give to your patient is entirely up to you. When you submit your case, you're able to request a 3-week, 2-week or even 1-week wear schedule, and dispense as many aligners as you see fit at each appointment. We recommend that your patient wear each set for at least two weeks for optimum results.

We also consulted with Dr. Fischer on this topic:

What should a doctor consider when deciding what wear schedule to choose for a patient?

95% of cases will be best suited for the 2 week wear schedule. That is the appropriate time it takes the skeletal and periodontal changes to occur with adequate tooth movement. 1 week intervals may be used when using accelerators such as; Acceladent (vibration), Propel (microperforations), Biolux/OrthoPulse (selected wavelengths of light) and Wilcodontics (surgically assisted orthodontics). (When using any of these the dentist will need to closely monitor for root resorption or other complications of moving teeth too fast.) 1 week intervals can also be OK when there is a minor amount of overall movement necessary for correction. 3-4 week intervals are good when there is questionable compliance or particularly difficult movements to accomplish.

Also, one may suggest that "young" teeth move more quickly and "older" teeth move more slowly due to the biological skeletal remodeling process, therefore the wear schedule for younger teeth can be shortened (1 week) and lengthened (3-4 weeks) for older teeth. However, clinical circumstances exert more influcence on the optimum wear schedule than the age of the teeth.

The health of the tooth is not as important as the health of the supporting bone and periodontal tissues when determining the aligner wear schedule. Even devitalized teeth can be moved if the periodontium is healthy.

Wear schedules can be changed by contacting one of our support representatives either by phone, email or by sending us a chat.

Thanks Dr. Fischer for sharing your experience and wisdom! 

Until next time... 

Tech Tip: Posterior open bite with clear aligners

A posterior open bite is when the upper & lower anterior teeth are touching when the patient bites down, but the posterior teeth are not in occlusion.

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Causes

There are many possible causes for a posterior open bite and it is fairly common with clear aligners. Usually it's temporary. It can be caused by the “hinging” action of the jaw.

Imagine placing a 1 mm sheet of flat plastic over the occlusal & incisal surfaces of the lower teeth. As the jaw closes, the posterior teeth will contact first. The patient would have to bite down firmly to get the anterior teeth to touch completely.

The same thing can happen when the teeth are covered by clear aligners. When the patient first starts wearing them, the posterior teeth are the first to contact. After wearing the aligners for a while, the teeth adjust to compensate, and before long, the patient can bite evenly with the aligners on.

The posterior teeth will intrude slightly to accommodate for the thickness of the aligners as occlusal forces are applied. Once the teeth have adjusted to the aligners, if the patient removes the aligners and bites down, the anterior teeth will make contact first and the posterior teeth probably won't quite touch.

Solutions

Here are some common approaches for a posterior open bite.

For posterior open bites present during clear aligner treatment:

  • Remember to check the occlusion during treatment visits and look for signs of posterior open-bite. Request a revision to slightly intrude the anterior teeth by ~0.5mm - 1.0mm on both arches, depending on the amount of open-bite. This relative intrusion will allow the posterior teeth to extrude, thereby closing the posterior open-bite.
  • To assist with re-establishing posterior contact, an open tray approach can be taken. Cutting off the aligner at the terminal molar to establish contact and gradually working your way forward until a canine to canine tooth aligner is left and posterior contact is established.

For posterior open bites present after clear aligner treatment:

  • After the patient has worn the final retainer for 3-6 months and the teeth are stable, the patient can switch to wearing the retainer on alternate days to give the posterior teeth freedom to move back into their normal position.
  • Or you can have the patient try the combination of wearing the upper retainer one night and lower the next and so on.
  • A Hawley retainer could be prescribed, which won't interfere with occlusion, allowing the posterior teeth to super-erupt freely.
  • A fixed retainer is also another option.

If you liked this article, check out our Help Center which is abundant with helpful information on clear aligner treatment.

Until next time...

Now offering dimple pliers

We’re happy to announce a new addition to our online store! Five Star Orthodontic's 1mm Retention Dimple Plier.

This plier is recommended for use when making dimples. You can pre-order these new pliers and save 10% by entering the promo code: PLIERS when ordering. The pre-order sale expires on August 4th.

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1mm Retention Pliers

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Dimpling is used as a chairside measure to increase pressure on the tooth for difficult movements or to add retention.

Use them to place small 1mm x 1mm deep dimples into your aligner. Unlike similar pliers from other companies, these pliers do not require heating of the aligner or plier.

We’ll be offering these pliers for $90.00, but for a limited time, you can save 10% by using the promo code.Take advantage of the pre-order price as it will only be available until August 4th.

  Click to pre-order!

Estimated shipment - August 4th

Tech Tip: Where to place dimples

A dimple is a small depression made in the plastic of the clear aligner. The dimple  increases pressure on a tooth to help make desired tooth movements or to increase retention of the aligner. 

Uses

Dimples can be used for:  

The force made by dimples will only be as strong as the aligner’s strength, so it's best to place dimples in a fresh aligner that has not been worn yet or request a remake of the aligner if retention is inadequate.

Overcorrection & Dimpling:

If overcorrection is requested in the treatment setup, it reduces and often negates the need for dimpling. Whenever possible, planned overcorrection in the treatment setup is more advantageous than making dimples (since dimples need to be made for each aligner and are generally limited to one or two teeth).

Dimpling is used as a chairside measure to increase pressure on the tooth for difficult movements. However, the amount of tooth movement is limited as there must be adequate space on the opposing side of the dimple within the aligner to allow the tooth to move. Often this is limited to the size of the air gap between the aligner and the tooth.

There are different approaches to overcorrection and dimpling. Some clinicians prefer to utilize overcorrection as much as possible and dimple only for difficult movements. Others do not plan overcorrection and dimple the aligners as needed, however as described above, dimpling only works for select movements.

How to... 

Dimples are made using a dimpling plier. Be aware that different manufacturers make dimpling pliers that produce slightly different sized dimples and some pliers require heating while others do not. Refer to the plier manufacturer for specific instructions.

Where to place dimples:

For added retention:

  • To add additional retention to aligners - place a dimple between two teeth on the lingual and facial sides of the aligner.

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For rotations:

  • For distal rotations - place dimples on the lingual mesial and facial distal side of the tooth.

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  • For mesial rotations - place dimples on the lingual distal and facial mesial side of the tooth

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For tipping:

  • For facial tipping place dimples on the lingual mesial and distal sides of the tooth.

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  • For lingual tipping place dimples on the facial mesial and distal sides of the tooth.

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  • For mesial tipping place dimples on the lingual and facial of the distal surface of the tooth on the occlusal 1/3.

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  • For distal tipping place dimples on the lingual and facial of the mesial surface of the tooth on the occlusal 1/3.

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For torquing:

(Engagers are recommended for torquing but not for small movements. Fresh aligners are the best option to get a tooth to torque. You may end up needing more than one replacement for stubborn teeth.)

  • To torque lingually place one dimple on the facial gingival. 
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  •  To torque facially place one dimple on the lingual gingival.

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  • To torque mesially place dimples on the lingual and facial of the distal surface of the tooth on the gingival.

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Dimples_-_torque_mesial_FD-4.jpg

  • To torque distally place dimples on the lingual and facial of the mesial surface of the tooth on the gingival.

Dimples_-_torque_distal_LM.jpg

Dimples_-_torque_distal_FM.jpg

For translation:

(Engagers are necessary for large mesial and distal movements. IPR may be needed if there is contact preventing movement.)

  • To translate lingually place dimples on the facial occlusal 1/3 at the center and on the facial gingival.

Dimples_-_translate_lingual_F-3.jpg

  • To translate facially place dimples on the lingual occlusal 1/3 at the center and on the lingual gingival.

Dimples_-_translate_facial_L-4.jpg

  • To translate mesially place dimples on the lingual distal surface of the tooth on the occlusal 1/3 and gingival. And place dimples on the facial distal surface of the tooth on the occlusal 1/3 and gingival.

Dimples_-_translate_mesial_LD-3.jpg

Dimples_-_translate_mesial_FD-4.jpg

  • To translate distally place dimples on the lingual mesial surface of the tooth on the occlusal 1/3 and gingival. And place dimples on the facial mesial surface of the tooth on the occlusal 1/3 and gingival.

Dimples_-_translate_distal_L-4.jpg

Dimples_-_translate_distal_F-3.jpg

The information provided above on where to place dimples can be found in our Help Center and referred to at your convenience. We hope you find it useful!

Keep an eye out for our upcoming pre-sale announcement for dimple pliers!

Until next time...