Tech Tip: Clear aligner therapy with Dr. Melissa Shotell

This week we're serving up content from ClearCorrect provider Dr. Melissa Shotell - who was both interviewed and published recently by Dental Product Shopper.

First up we have a case study that looks at a case with 3D scans treated by Dr. Shotell:

A 20-year-old female who was concerned with traumatic occlusion to her anterior teeth presented for an orthodontic consultation. The patient had limited overbite and overjet with mild spacing in the lower incisors. Additionally, the patient had a strong preference for clear aligners...

Next, check out the recent interview that was done by Dental Product Shopper:

“I was looking for flexibility to place and remove attachments throughout treatment to give detailed movements,” said Dr. Shotell. “I also wanted to be able to make modifications throughout the treatment process and order aligners as needed. The Unlimited case from ClearCorrect gives me this flexibility.”

Hungry for more? You're in luck! Dr. Shotell has a full-day hands-on workshop coming up in Philadelphia, PA. Register today to learn more from this leader in clear aligner therapy! 

shotell philly image

Tech Tip: Finishing a case - best practices

At the end of treatment it's important to assess whether you and your patient are satisfied with the results. 

Sometimes, your perception of a nicely finished case is different from the patient’s. When you give the patient an opportunity to express their satisfaction of the treatment result before announcing that treatment is finished, your patient will feel like you care about how the they feel about their result. It also gives you the opportunity to correct any remaining undesirable issues.

Here are our recommended best practices for finishing cases.

Identify potential issues prior to the last aligner

Before delivering the last aligner to your patient, evaluate for the presence of any of the following conditions and determine if they need resolution before you tell your patient “You’re finished!”:

  • Residual spaces: Small, interproximal spaces may still exist due to a variety of reasons, e.g. patient has not worn their aligners sufficiently to close the spaces, excessive IPR had been done, or space existed in the approved setup.
  • Incomplete rotations: If a tooth has not finished its rotation correction, the patient will undoubtedly be aware of it and not consider their treatment finished.
  • Teeth are not aligning as expected: Alignment is not as expected – if teeth are not aligned as seen in the setup, it is important to determine the cause as soon as noticed; most often, the discrepancy is due to the lack of required space, i.e. insufficient arch expansion or IPR (see images).

incomplete rotation-1incomplete rotations 2-1

  • Irregular or uneven incisal edges: A tooth may need enamoplasty or need to be intruded or extruded to level its incisal edge with adjacent teeth.
  • Marginal ridges: The misalignment of the marginal ridges of adjacent teeth may indicate a tooth should be tipped to improve its axial alignment.
  • Occlusion not fully interdigitated or idealized
  • Posterior openbite: While the etiology of these openbites may be uncertain, an appropriate resolution should be offered to the patient before the delivery of their retainer.
  • Black triangles: These unsightly interproximal spaces can be visually unsettling to the patient and should be managed proactively in an appropriate manner.

When you're ready to order the retainer

Once both you and your patient are satisfied with the treatment outcomes, it's time to order the retainer. Following is the process for ordering the first set of retainers at the end of clear aligner treatment. Retainers can also be purchased at any point post treatment.

For a new patient (not treated with ClearCorrect) there is a different process. Please see this article for those instructions.

  • Retainers can be ordered based on PVS impressions, intraoral scans or a previous step. Decide which option you want for your patient and have them ready.
  • Locate your patient in ClearComm. They may be under "In progress" or "Closed".

manage-cases

  • Click on a case to go to the case page.

all-phases-shipped

  • Click the REQUEST RETAINER button.
  • Let us know if you're submitting impressions, intraoral scans or if they will be based on a previous step.
  • Indicate how many retainers you want to order.
  • Apply any discounts & select your preferred shipping method.
  • Select your payment method and click "Submit". 
    • For legacy cases that have never been closed:
      • the first set of retainers is included (plus shipping), if it is based on an existing step.
      • Additional fees apply for retainers based on impressions or scans.
      • Additional retainers may be added to the order at a discounted rate.
    • New Unlimited cases include up to two sets of retainers every six months.
    • All other retainers are available at standard Flex prices.

ordering retainers 7

  • 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.

Ordering Retainers 6

Retainer appointment & retention protocols

  • When scheduling your patient's retainer appointment, make sure that you allow enough time for the shipment to arrive at your practice.
  • Educate you patient during the retainer appointment about the way that it works in preventing the relapse of teeth. You may also want to educate them in the importance of complying to your suggested wear schedule.
  • Determine the retention protocol for the patient. The type of retention protocol you select can depend on the type of treatment, any post treatment corrections and even patient preference.
  • A typical retention protocol used by an experienced orthodontist:
    • Last aligner for 2 months
    • Clear aligner retainer for 2-6 months full-time wear
    • Continue removable retainers bed-time wear
    • 6 month follow-up retainer check appointments until done

Tech Tip: Acceptable impression trays update

We recently conducted a review of the impression trays that we can and cannot accept. For those providers who are submitting PVS impressions, here's what you need to know:

Acceptable trays

Any brand of disposable single-arch impression tray is acceptable for submitting cases. Impressions in single-arch plastic trays can be scanned cleanly without being poured up as a stone model. Remember, we cannot return impression trays.

disposable trays

Unacceptable trays

Metal trays and mesh trays are unacceptable, as are stone models.

Metal trays cannot be used because they interfere with the scanning process. (And, of course, they can't be returned.)

Mesh trays (sometimes known as "triple trays") are often too shallow to capture an adequate 2-3 mm gingival margin, and incisal detail is often lost as teeth impinge on the mesh. The scanning software does not recognize multiple arches at once, so these trays must be poured up in stone, which reduces accuracy further and introduces delays.

mesh tray 2mesh traymetal impression trays

We have not accepted metal trays for some time now.

Effective May 1, 2018, ClearCorrect will no longer accept mesh impression trays for patient records.

If you have any questions, please feel free to contact one of our provider services representatives.

Tech Tip: Before you submit a case revision

There are any number of reasons your case might need a revision, the most common being when teeth don't move as planned. You can check for any of the following possible issues that can potentially be resolved without having to submit a revision:  

Aligners don't fit - Incisal Gaps

 incisal gap
An incisal gap (large or small) is when there is a gap between the incisal edge of the tooth and the aligner. Incisal gaps are usually the first sign of a case going off track.

Troubleshooting options:

Aligners don't fit - Rocking

Fit one side not other

Rocking is when one side of the aligner first but the other does not. The side that is tracking will fit nicely (flushed), but the side that is tracking poorly will not want to sit at all.

Troubleshooting options: 

  • Check for impression distortions in the original impression
  • Try the following steps:
    • Seat the aligner on one side
    • Align the aligner over the teeth on the opposite side
    • Using your thumb on the aligner over the first molar, push the aligner toward the teeth
    • Rotate the thumb down and toward the gingiva, torquing the aligner onto the teeth
  • Section the aligner at the midline and seat each half independently

Non-compliant patients

 non-compliance

Non-compliant patients are patients who are not following their recommended wear schedule (at least 22 hours a day). Compliance is the most common reason things go off track during treatment.

Troubleshooting options: 

  • Document the non-compliance
  • Re-state wearing instructions and importance
  • Show them their treatment setup so they know what results await if they stick to their treatment plan
  • Extend the time the patient has to wear their current aligners
  • Remind them of the alternative treatment (braces) & about the time/money spent on clear aligner treatment
  • Consider terminating the patients treatment vs. having the treatment fail

Tight Contacts

 checking compliance 2-1

Tight contacts exist when there is tension or compression between two teeth. Tight contacts between teeth exist naturally when the collective size of the teeth (the cumulative total of the mesiodistal width of all teeth in an arch) is larger than the amount of room available for those teeth in the supporting bone. The natural condition of properly aligned teeth in a dental arch does not find them tightly compressed together into a "tight contact", only "in contact with each other."

Troubleshooting options: 

  • Floss between the suspect teeth to check for tight contacts
  • Check subgingival too
  • If tight contacts exist, hand stripping can be done to create 0.1 mm of IPR

You can find more information about clear aligner treatment, invisible braces and/or ClearCorrect in our online Help Center.

AAO Speaker Schedule

ClearCorrect Speaker Schedule

Attending the 2018 AAO Annual Session? Be sure to stop by booth #2201!

We've got an all-star lineup covering brand-new topics, from case selection to advancements in clear aligner technology, plus live demonstrations throughout. You don't want to miss this!

Saturday, May 5th

11:15am Dr. Jason Battle Interceptive Orthodontics with ClearCorrect
11:45am Dr. Melissa Shotell The ClearCorrect Digital Workflow: Integration into Everyday Practice
12:15pm Rosemary Bray Make Your Place of Employment a Place of Enjoyment
12:45pm Dr. Steven Olsburgh Optimizing Aligner Therapy with Remote Monitoring
1:10pm 3Shape Live TRIOS Demonstration: Sending a Case to ClearCorrect
2:00pm Dental Wings Comfortable Scanning Experience with CARES Intraoral Scanner

Sunday, May 6th

11:15am Dr. Ken Fischer How to Avoid Revisions
11:45am Dr. Melissa Shotell The ClearCorrect Digital Workflow: Integration into Everyday Practice
12:15pm Dental Wings Comfortable Scanning Experience with CARES Intraoral Scanner
12:45pm Dr. Dan German Cone Beam and Clear Aligner Therapy: A recipe for optimal outcomes!
1:10pm Philippe Salah AI and the Future of Orthodontics
2:00pm 3Shape Live TRIOS Demonstration: Sending a Case to ClearCorrect

Monday, May 7th

11:15am Dr. Jason Battle Tips for Addressing Class II and Class III Cases
11:45am Dr. Ken Fischer How to Avoid Revisions
12:15pm Rosemary Bray Make Your Place of Employment a Place of Enjoyment
12:45pm Dr. Dan German Cone Beam and Clear Aligner Therapy: A recipe for optimal outcomes!
1:10pm Dr. Steven Olsburgh Optimizing Aligner Therapy with Remote Monitoring
1:30pm Dental Wings Comfortable Scanning Experience with CARES Intraoral Scanner
2:00pm 3Shape Live TRIOS Demonstration: Sending a Case to ClearCorrect

Tuesday, May 8th

11:15am Dr. Ken Fischer How to Avoid Revisions
11:45am Dental Wings Comfortable Scanning Experience with CARES Intraoral Scanner
12:15pm Philippe Salah AI and the Future of Orthodontics

Tech Tip: Submitting a case revision - best practices

There are any number of reasons your case might need a revision, the most common being when teeth don't move as planned.

When you request a revision your patient's treatment will be re-staged to target the original treatment goal, starting from the current position, unless you have requested otherwise. 

If you have to submit a revision, we want it to be as simple and effective as possible. Below are our suggested best practices for submitting a revision. 

Submitting a revision

Case revisions must be submitted online. Here's a step-by-step for submitting a revision along with some important tips.

1. If submitting new impressions or intraoral scans, take them before starting the online submission process.

Tip: Remove all existing engagers before taking new impressions to improve accuracy. Reason being that we cannot assure the existing engagers will be accurate with the fit of the new aligners.

2. When you select a case with a phase scheduled, you'll see a blue "Revise" button in the action area. After you click that, the title will change to "Requesting revision."

revision 1

3. If all planned phases have shipped, you will find the case under the "closed" tab and it will look like this:

revision case closed

4. Select the correct step number for each aligner the patient is currently wearing & have the patient continue to wear the current step until the revision arrives.

5. Select if you want us to base the revision on existing models, on new impressions, or on new intraoral scans.

  • If the current aligners fit well and you just want to request a change (i.e., adding engagers or requesting overcorrection), select "Existing model."
  • If you select "New impression," you'll be presented with an option to ship it after you submit the revision request.
  • If you select "New intraoral scan," you can upload it along with the revision request, or submit the request first and upload the scans later.

6. Instructions: Describe the existing condition of the treatment and indicate any issues that you wish to overcome in the revision. Be as detailed as possible. The more information you provide the better. For example, Engagers on #6-7 are not tracking with aligner. #7 is not rotating as planned. (If your instructions are unclear, you will be contacted by email to confirm before we manufacture your revised phase.) 

Specify any additional requests or information, such as: 

  • If you would like to overcorrect any teeth in the revision.
  • Note any engagers that are misbehaving. (Engagers that are not tracking can be a sign of bigger problems than just fitting issues.)
  • If you would like additional engagers.

Tip:  If you would like the same engager placement in your revision, you will need to specify in the revision instructions which teeth you would like the engagers to be placed and/or remain in the treatment. 

Tip: If you're submitting a revision for “ill-fitting aligners”, for "engagers not fitting in the aligner" or for a specific tooth "not tracking", there isn’t a way for us to determine the patient’s current condition unless new impressions or scans are sent in. So for these types of revision submissions we always require new impressions/scans to get to the root cause.

revision interface

7. Once you are complete with your instructions, select "Submit" and you will receive a revised treatment setup within a few days for your approval. If you want to print a copy of the revision for your records, you can download one by clicking the revision form icon in the case history.

Revision history

Identifying the revision on the treatment plan

When you request a revision for a case, the treatment plan will reflect that you have received the revision with a small break as in this image.

Revision treatment plan

All revisions are numbered based on the next odd aligner in sequence. For example, if the patient is wearing step 7, then the treatment and revision setup will now begin on step 9, regardless of how many aligners we’ve shipped in between. 

When not to send a revision

Following are circumstances when you should not send a revision:

To request any of the above actions, contact one of our helpful Provider Services representatives and they can assist you.

Tech Tip: Common photo mistakes

We know that taking quality intraoral photos can sometimes be difficult, so we recently published an article with information and tips for taking clinical photos. This is a follow up to that article with some examples of common photo mistakes to be aware of when taking clinical photos and submitting your cases. 

Common photo mistakes

 

photos mistake 1 This front view doesn't demonstrate the bite relationship, because the mouth is open andthe teeth aren't touching. We need to be able to see how the teeth are fitting together.
photos mistake 2 This lower occlusal view shows too much of the facial surfaces of the teeth, and not enough of the occlusal surfaces. It's also blurry and over-exposed.  One option is to use a smaller F-stop if the camera has this capability. Zooming out is also a possibility, but with that there will be a general loss of resolution and it is hard to hold the camera steady while zoomed in, so with this option there may be some blurring due to slight movement.
photos mistake 3 This front view is washed out and unusable, because the camera was too close to the mouth when the flash went off. Step back and zoom in to correct this problem.
photos mistake 4 The angle of this profile photo is too far behind the patient and too high, making the shape of the jaw difficult to see. The camera lens should be level and parallel to the side of the patient's face. (This patient's eyes have been obscured to protect his privacy.)
photos mistake 5 The angle of this right lateral view is too far forward. We need to be able to see the full buccal surfaces of both six-year molars to accurately determine the molar relationship.
photos mistake 6 This occlusal view is off-center, and doesn't show enough of the molars. Most patients won't be able to open their mouths widely enough to take good photos unassisted. We recommend using an intraoral mirror and retractors.

Tech Tip: Taking clinical photos

ClearCorrect requires you provide clinical photos for each case you submit. Photos help us understand your prescription and interpret your instructions.

Proper patient photos of the patient's true occlusion are required so that initial articulation can be set properly. No matter the number of teeth that are moving, initial articulation is maybe the most important aspect of a treatment plan. If this is set incorrectly, every movement made, no matter how minor, could result in a negative or worsened outcome for the patient. Outside of that, we also need to ensure that the materials we have belong to the patient so that no time is wasted on creating a setup that does not belong to the patient, or wasted time for the doctor reviewing an incorrect setup.

Your photos will need to be uploaded as digital files when you submit your case in ClearComm. The most important thing is to include clear, well-lit photos, in focus from all eight angles.

Eight Angles

Below are the eight different photo angles required for your submission. These photos will help us produce the best aligners possible:

  • Full face (not smiling)
  • Full face (smiling)
  • profile (not smiling)
  • Front view
  • Right lateral view
  • Left lateral view
  • Upper occlusal view
  • Lower occlusal view
photos image

Watch this video on how to take photos and x-rays.

Taking clinical photographs

There are plenty of courses you can take to gain skill and become more proficient in clinical photography if interested. Here we are offering some quick tips and suggestions for taking good quality clinical photographs.

Materials

  • To take good quality photos you'll need the following materials:

    • Digital camera (a camera with ring flash and a dedicated macro lens will produce the best results for intraoral photography)
    • Cheek retractors 
    • Intraoral mirrors (full arch and lateral view in both adult and children sizes)
    • A solid white wall or background (poster or foam board can be purchased and used instead of a wall). This helps make sure that the patient's facial features are clear in the photo.

         Optional, but preferred:

    • A wall-mounted back light equipped with a "slave" flash is preferred, instead of a wall or other background (For example, the "Image Minder Back Flash and Dental Light Box" offered by Photodent USA)
    • A vertically adjustable stool or chair 

photo materials


Positioning

For all extra-oral photos the patient should be at a comfortable, direct, 90-degree angle to the camera. For taller patients that may mean that the camera needs to be raised or the patient lowered and vice versa for shorter patients. An adjustable stool or chair enables the assistant or photographer to properly orient the patient's mouth to the camera. 

Full face (not smiling) 

  • Frame the patient's face from the top of the head to the middle of their neck, with the camera oriented vertically
  • Camera distance from the patient is determined by optimum focus at the lens' focal length providing the maximum depth of field (each lens may be different)
  • Patient's head should be oriented vertically in a natural and relaxed position
  • Patient should look straight ahead directly into the camera lens
  • Patient should have their lips, jaw, and teeth in their natural and relaxed position with lips together
photos 1

Full face (smiling) 

Same as above, plus:

  • Patient's smile should be natural
  • Teeth should be visible
 photos 2

Profile (not smiling) 

  • Patient's body is turned 90-degrees to their left so that their right shoulder is pointed directly at the camera and only the right side of their face is visible to the camera
  • Patient's head should be in a natural and relaxed position
  • Patient's eyes should be horizontal and looking straight ahead
  • Patient's hair should be pulled back, behind their ear, if long
DSC_4010 v2 

For all intra-oral photographs the patient can/should be in the dental chair. The patient and/or a dental assistant can help with the cheek retractors.

Front view 

  • Use cheek retractors to pull lips away from the teeth and gums
  • Lips and cheek retractors should not obscure any of the teeth
  • Camera should be horizontal, with the occlusal plane level in the center of the frame
  • The buccal corridors (the area between the buccal teeth and the inside of the cheek) should be well-lit and visible
  • Proper depth of field (determined by the lens) will provide focus from the central incisors to the first molars; operator should focus on the canines/first premolars
  • The upper and lower gingival sulcus should be visible
DSC_4381 v3

Right lateral view 

  • Have patient turn their head to their left so the right side of their face is towards the photographer
  • Use one cheek retractor to pull the right lip away from the teeth and gums, so that the right central to the last erupted molar is visible (if possible). Note: Try to do this step just before taking the picture so the patient is only uncomfortable for a few seconds and so that you can get as far back as possible.
  • Camera should be horizontal, and be pointed in a perpendicular angle to the buccal surface of the teeth with the occlusal plane level in the center of the frame
  • If the lips cannot be retracted far enough, with the help of another person or the patient, position a buccal mirror to capture the mesial of the second molars (if erupted), then repeat the previous step
  • Crop the frame so there is a minimum of distracting retractors and lips (see photos)
DSC_4369 v3

Left lateral view 

  • Have patient turn their head to their right so their left side of their face is towards the photographer
  • Repeat the steps in the previous section
DSC_4373 v3

Upper occlusal view 

  • Use a retractor to pull the upper lip away from the teeth
  • Insert the wide end of the arch mirror to capture the arch. Note: Pulling down slightly on the mirror can help to get the whole arch up to the last molar.
  • Patient may tilt their head forward so photographer can get the camera 90-degrees to the mirror plane
  • The framing should be square to a vertical line down the midline of the palate
  • Show the full occlusal surface of the arch
  • Try to get as little of the retractor in the picture as possible
DSC_0569 v4

 Lower occlusal view 

  • Use a retractor to pull the lower lip away from the teeth
  • Insert the wide end of the arch mirror to capture the full arch. Note: Pushing upward slightly on the mirror can help to get the whole arch up to the last molar
  • Patient may tilt their head backward so photographer can get the camera 90-degrees to the mirror plane
  • The framing should be square to a vertical line down the midline of the lower arch
  • Show the full occlusal surface of the arch
  • Try to get as little of the retractor in the picture as possible
DSC_0573 v4

Tips on taking photos

With most cameras, pressing the shutter button (the button that takes the photo) half way (before you feel that main resistance before the "click") before actually snapping the photo will help to focus the photo. Snapping the photo without first giving the lens a chance to focus usually results in blurry photos.

Light is your best friend. It's what makes photography possible. So it's always best if you can take your photos in the most well-lit area of your office. A ring flash matched to your digital camera and mounted on the front of the lens is the best way to adequately provide enough light for intraoral photos. 

Avoid getting too close to what you're photographing. Many cameras have a hard time focusing on things that are extremely close; in addition, if you have to use flash, the flash will wash out a lot of the detail in the shot if you're too close. Instead, take a tiny step back and simply zoom in on the subject.

Before and after photos

You already have to take the "before" photos when you submit a case to us. Upon placing the final retainer, we always encourage doctors to take a series of "after" photos, to keep a record of how effective the treatment was.

To submit after photos, simply take photos using the same angles you used in the submission process and send them to feedback@clearcorrect.com

We love seeing those new smiles, and doctors who take the trouble to take an extra series of photos are always glad they did! Great treatment outcomes are the strongest tool you have for growing the clear aligner aspect of your business.

Tech Tip: Impressions FAQ

Despite the increase in intraoral scanners available today, many doctors still prefer to use impressions to submit their cases to ClearCorrect. Here are answers to some of the FAQs about impressions and ClearCorrect. 

Our terms & conditions state: 

"Alginate impressions, stone models, and metal impression trays will be rejected. These and all other submitted materials become the property of ClearCorrect and will not be returned."

no metal trays-1Why doesn't ClearCorrect accept alginate material for impressions?

Alginate dries out and the material itself can shrink or expand depending on environmental factors. This can make the aligner too big or too small, depending on any changes.

Why can't I submit my case with metal trays?

ClearCorrect does not accept metal trays because they're incompatible with our scanning process. 

Why do you need both arch impressions/scans for a single-arch case?

We need both arches for a couple reasons:

  • We need to know where the opposing teeth are located to prevent inter-arch collision or hyper-occlusion when moving teeth to their final position.
  • When improving the overjet, overbite, midlines, canine, premolar, and/or molar relationships, we need to have the opposing arch to setup the correct relationships.

How does the impression tray size and material affect the fit of the aligners?

An impression tray that is too small can have several ramifications:

  • Prevents all teeth from being fully captured in the impression. 
  • The molars may lift from the tray which can ultimately skew the tooth shape and arch form.
  • Can potentially cause the patient to cut through the impression material all the way to the tray and leave holes in the impression.
  • Can prevent capturing the full gingival margin.

impression holes

If a tray is too big, the impression material may be spread too thin, which may make it difficult to fully capture the gingival margins. 

Using too much light-body material, using too little material, or not using light-body at all can also reduce impression accuracy. These procedural errors may cause voids or thin walls, among other issues, which affect the fit of the aligner. 

impression incorrect

Why can't we send stone models?

stone model

Stone models don't always survive the shipping process. There is usually some sort of chipping, especially along the cusps/incisal edges. Sometimes this can be a whole tooth, but most of the time it will be something minor that's hard to detect but can still affect the fit of the aligners. 

Also, with stone models, we can't control the quality of the stone model. The impression might be perfect, but if the pour-up is bad the scan will be compromised. Things like air bubbles can be filled in, but it leaves us guessing at what the shape of the tooth is actually like.

no bite registrationWhy aren't bite registrations required with my ClearCorrect case submission?

Bite registrations are not required to submit your case because our software automatically articulates the arches in maximum intercuspation. For the vast majority of cases, this is as accurate as (or more accurate than) aligning models based on a bite registration. Our technicians also double-check the occlusion against the photos you provide. 

Bite registrations will not be scanned unless specifically requested (either in the prescription form or in response to the technician in a setup decline).

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

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

  1. Make sure that you're using a correctly-sized tray. It should extend past the last tooth in the arch without touching the gums.
  2. Before inserting the tray containing light body, add some light body directly to the occlusal and distal portion of the last tooth in the arch, ensuring that the last tooth is completely covered with impression material.

Check out our Help Center for more information on the topic of impressions:


Tech Tip: Clear aligners and bisphosphonates

We sometimes get questions about the use of bisphosphonates while undergoing clear aligner treatment.  Here's our take on this topic:

Bisphosphonates

Bisphosphonates are a class of drugs that are used to treat osteoporosis and other diseases involving bone fragility and/or loss of bone mass. These drugs effect bone metabolism by inhibition of osteoclastic activity.

osteoclastic-diagram-6-v2.jpg

The disruption of bone metabolism may have as small of an effect as slowing the rate of tooth movement during orthodontic treatment to as drastic an effect as bone failing to heal post-extraction. Much depends on the individual, drug dosage parameters, time and duration of bisphosphonate therapy, pharmocokinetics and other variables.

The option for the patient to be treated with clear aligners for orthodontic movement depends upon the dentist's evaluation of the totality of the patient's condition and the severity of the involved mitigating circumstances. 

Variables including (but not limited to) patient medical history, overall oral health and the treatment being performed, are all factors that can affect the decision of whether or not to perform orthodontic treatment on a patient who is taking or has taken bisphosphonates. 

It is the dentist's responsibility to be informed and familiar with their patient’s medical history and any interactions the patient’s medications may or may not have upon the orthodontic treatment. Consultation with the patient's physician may help to answer specific questions.

What effects do bisphosphonates have on clear aligner treatment?

The relatively gentle pressures associated with tooth movement caused by clear aligners generally does not disturb this activity sufficiently to result in osteonecrosis (the death of bone tissue) of the jaw. However, if your patient is taking or has taken medications containing bisphosphonates, be advised that these drugs may interfere with the patient’s bone’s ability to remodel normally, which may affect the efficacy of the aligners to move teeth.

A helpful literature reference for more information about bisphosphonates and how they may affect different types of orthodontic treatments can be found here

Bottom line: A history of bisphosphonate therapy does not automatically preclude orthodontic treatment with clear aligners. However, it is the dentist's responsibility to determine if clear aligner therapy is appropriate for that particular patient.