ClearCorrect: Essential to My Digital Workflow

Dr. Meena Barsoum recently talked with Dental Product Shopper (DPS) about his experience using ClearCorrect--a more streamlined approach to clear aligner treatment processes. "The big driver for me personally is the ability to submit digital scans. Not only am I able to submit a more accurate impression for the ClearCorrect prescription, but the process is just that much easier for my patients and me," says Dr. Barsoum.

After consulting with his patient about clear aligner therapy, he is able to take a full mouth digital scan, and then submit the scan to the ClearCorrect online doctor portal within minutes. This quick turnaround time is huge for his practice and patients. He is able to quickly show the patient what their smile will look like at the end of treatment and walk them through all of the treatment steps. 

ClearCorrect's customized treatment setup plan (example below) allows doctors to review the digital representation of the complete course of treatment. The treatment setup contains 3D models for each step of the treatment, representing the tooth movements that the doctor prescribes. Once the doctor and patient approve the treatment setup, the models will be printed and used to manufacture clear aligners which are then delivered 2 to 3 weeks later.

 

"Making ClearCorrect a part of my practice has been very simple with convenient access to free online training covering advanced and basic aligner treatment topics. In addition, the online portal for submitting cases, making changes, and requesting retainers is easy to use. Also I have a dedicated account manager, and this available communication and support is a big benefit of working with ClearCorrect," continued Dr. Barsoum. 

Read the Dental Product Shopper full article here. 

Now offering ContacEZ IPR Strips & Snap-On Disc Guards

It's our pleasure to announce a new addition to our online store: ContacEZ IPR Strips and Snap-on Disc Guard. 

Pre-order these new items and save 10%. Enter promo code: PRESALE when ordering. Pre-order prices are for the ContacEZ IPR Strips and Snap-On Disc Guard only and are available until May 3rd.

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We're happy to offer both of ContacEZ's IPR strip systems in three convenient packages.

IPR Strip System Package

These strips help to make IPR safe and more accurate without creating sharp corners. The strips curve and flex along the natural contours of the teeth to prevent soft tissue irritation, helping to avoid cutting excessive enamel and maximize patient comfort.

We're offering this package for $190.00 with an additional 10% off with our presale promo code. It contains a total of 32 strips, 8 of each (Yellow Starter 0.06mm, Red Opener 0.12mm, Dark Blue Widener 0.15, Green Extra-Widener 0.20mm).

  • Single-handed design offers optimal tactile control
  • Will not cut lips or gums and eliminates gagging
  • Flexible strip will contour the curvature of the tooth without creating subgingival ledges or sharp corners
  • Reduce binding and prevent residual crowding
  • Easy access to tight anterior or posterior areas
  • Autoclavable up to 280 degrees (steam heat only, not dry heat), and multi-usable

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IPR Optional Strips Package

The strips in this package allow for in-depth personalization to suit the variety of different cases and clinicians' preferences involved in interproximal reduction. These strips contour the curvature of the tooth to safely and efficiently reduce interproximal enamel without creating sharp corners.

These optional strips offer a larger starter strip (0.10mm Clear strip), a single-sided 0.12mm widener (Cyan strip) and two thicker options for widening (0.25mm Purple widener and 0.30mm Brown widener).

We're offering this package for $190.00 with an additional 10% off with our presale promo code. It contains a total of 32 strips, 8 of each (Clear Single-Sided Opener, Cyan Single-Sided Widener, Purple Super-Widener, Brown Mega-Widener).

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ContacEZ IPR Strips - Combined Package

This package combines the IPR Strip System and the IPR Optional Strips packages for $245.00 with an additional 10% off with our presale promo code. The combined IPR strip system contains 8 of each of the IPR Strip System strips (yellow, red, dark blue and green) and 2 of each of the Optional Strips (clear, cyan, purple and brown) a total of 40 strips per box.

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Don't want any of the packages? No problem! Each of the IPR Strips are also being sold in our online store individually in a refill package of 8 or box of 32. 

Snap-On Disc Guard

Using these guards during interproximal reduction with discs helps to protect your patient's tongue, lips, cheeks and gums from IPR discs. We're offering 1 package which contains 20 disc guards for $40.00 with an additional 10% off with our presale promo code.

  • Quickly snaps on and off
  • Provides safety and peace of mind
  • Economical and cost-effective
  • Transparent plastic
  • Clearly see the spinning disc
  • Single-patient use, disposable
  • Can be used with discs, rubber wheel, and brush wheel

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We are offering these packages and each of the individual IPR strips along with the snap-on disc guard at these discounted prices for a limited time. Take advantage of these great pre-order prices as they will only be available until May 3rd.

  Click to pre-order!

Estimated shipment - May 3rd 

ClearCorrect Scores Another Victory With the Federal Circuit

Align Technology Fails Again to Overturn ClearCorrect Victory in Widely-Watched ITC Case

ROUND ROCK, TX--(Marketwired - March 31, 2016) - ClearCorrect, LLC, a leading U.S. manufacturer of clear aligners, is pleased to announce that the United States Court of Appeals for the Federal Circuit today denied the petitions for rehearing en banc that were filed by the International Trade Commission (ITC) and Align Technology, Inc. in case number 2014-1527. This is another U.S. court decision in favor of ClearCorrect, supporting the company's position that its clear aligner product complies with legal standards and does not infringe Align's patents.

The ITC or Align Technology may ask the United States Supreme Court to review the case, but such a review is unlikely to occur under the present circumstances. Last November, the U.S. Appeals Court ruled in favor of ClearCorrect, ruling that the ITC was without jurisdiction to regulate electronic transmission of data and today's reaffirmation of that decision is a victory not only for ClearCorrect, but the entire orthodontic industry.

"Denial of these petitions solidifies our victory in both actions we faced in the ITC," said Jarrett Pumphrey, ClearCorrect's CEO. "Based on the Federal Circuit's ruling last November, we expected today's outcome and are pleased that we will have no liability from either of these cases," he added.

"Today's result, coupled with last year's settlement of a civil action with Align where both parties agreed to dismiss their claims, means that three-quarters of the litigation Align initiated against ClearCorrect has now been resolved," said Michael D. Myers, ClearCorrect's attorney in the case and a partner with the Houston, Texas law firm McClanahan Myers Espey, LLP.

Align's final remaining lawsuit against ClearCorrect is a patent infringement case in a Texas federal court that had been stayed pending the resolution of the ITC actions. In anticipation of this case, ClearCorrect initiated reexaminations with the United States Patent and Trademark Office (USPTO) of 6 of the 9 Align patents asserted in the suit. The USPTO has the jurisdiction and authority to judge the validity of patents. Those key patents are now at risk of being cancelled, as thus far, the USPTO has indicated agreement with ClearCorrect's position that all 75 claims of the patents in question are invalid.

"Unless and until all the claims against the company are dropped or resolved, ClearCorrect must continue to defend itself. And those defensive efforts are progressing quite well," Myers said.

ClearCorrect case study: Dr. James Alexander

Orthodontic Practice US recently published a ClearCorrect case study: Dr. James Alexander discusses a way to avoid traditional PVS impression.

Utilizing CEREC scans with ClearCorrect for alignment

Tech Tip: Providers talk IPR

In a recent survey, we asked ClearCorrect providers to share their tips & tricks for performing IPR. As you'll see, we got a wide variety of responses, some of them contradictory. Everybody has their own preferred techniques.

Today, we're passing on some of the responses we got. Nothing here should be taken as official advice or recommendations from ClearCorrect or its employees—use your professional judgement to evaluate what's best for you and your patients.

Tools for performing IPR

Based on our responses, the most popular tools for performing IPR are diamond strips, followed by burs and diamond discs.

Doctors who prefer strips said:

  • “Floss first then diamond strip.”
  • “I usually underprepare the IPR so that the reduction gauge is difficult to fit between the teeth. If needed, more can be done later, often with a finishing strip, so that a closed contact can be reliably achieved.”
  • “I generally do IPR with manual strips every six weeks until contacts are not tight. I don't think this is better I am just more comfortable with this.”
  • “Pre-wedging prior to IPR and starting with strips prior to discs.”
    “IPR first with hand strips. Also, I find it easier to IPR when teeth are aligned first in the contact areas.”
  • “Start with the thin stainless steel strips and switch to the thicker carborandum strips as contacts become less tight.”
  • “I like to use a long finishing diamond to do IPR because I think it gives me more ability to maintain ideal proximal tooth contours.”

Doctors who prefer burs said:

  • “I find it’s easier to do IPR with burs as opposed to discs and strips. The smallest bur that I have found for 0.3mm is the mosquito interproximal from Neo Diamond. #1416f”
  • “I prefer a mosquito diamond to discs for IPR. I feel like I can shape it better.”
  • “I use ContacEZ high speed mosquito bur 1.6mm x 5mm length.”
  • “Mosquito burs are much easier to use and safer than discs, especially posteriorly.”
  • “I use a Brasseler mosquito bur from the cervical incisal to prevent lodging and make sure contact is completely broken.”
  • “I have stopped using the discs and use the mosquito bur to open the contact at the correct angle then I also use it to provide the correct proximal contours. Then I use the strips to finish to final IPR spacing and polish.”
  • “A high speed air turbine and bur seems to be the quickest and most controlled method.”

Doctors who prefer discs said:

  • “Start with low speed and stay in clear vision and control of the procedure. I use loupes 3x or microscope to do it.”
  • “It’s important to reduce straight (not angulated) and to carry the separation through the contact areas.”
  • “I use a slow speed straight hand piece with a VisionFlex disc. Fast and smooth and has many uses. You must be very careful.”
  • “Have different sized discs.”
  • “Just remember to use a guard on the wheel.”
  • “Use reciprocating files when extremely crowded and then rotary diamonds.”
  • “Use Brasseler perforated diamond disc - tissue guarded mandrel is an absolute must use.”

And some doctors prefer other tools:

  • “Always use diamond floss.”
  • “Use a combination of diamond discs on the slow speed hand piece with a soft tissue guard. Measure the amount of reduction done. Finish the IPR with hand strips. Check with an explorer to make sure that there is not a ledge left. Before starting any case involving IPR, inform the patient that it is needed.”
  • “I use a Komet, USA IPR kit with a reciprocating hand piece and safe tips. Then I finish with diamond strips to smooth and finish and contour. The gauges to confirm amount removed are integral as well.”
  • “I routinely perform IPR with a high speed hand piece and tapered carbide bur in conjunction with fixed appliance treatment. IPR occurs after separation of the contact points, and is performed on molars, bicuspids, and cupids as needed.”
  • “Use a high speed with a needle fine diamond. Check with the spacer key. Then round off the edges with the Diamond to restore anatomy. Done.”
  • “Get the electric wiggle saw. I do not know the name. Safe and effective.”
  • “On an extremely tight contact, I will place a separator for a few minutes prior to IPR. When I remove it and perform IPR, the patient is more comfortable and the strips do not break as often.”
  • “I use an oscillating hand piece made by Komet. It's easy to use and relatively comfortable for patients.

General thoughts on IPR

Some doctors prefer to perform IPR after aligning teeth, some from posterior to anterior and some prefer to perform IPR after arch expansion to allow access. Here are a few general tips from providers:

  • “Measure, re-measure, recheck before IPR, and also during the process.”
  • “Under IPR rather than over IPR.”
  • “The trick is to have the ClearCorrect technicians expand the arches to create more access to the area that is supposed to get IPR. I do use a mosquito nose diamond from SS White. It’s called a piranha diamond very fine, ISO FG# 392-016.”
  • “Do the posterior first, then anterior later.”
  • “Use a steady hand to be sure you don't open up too much space. I've used local anesthesia before on very sensitive patients.”
  • “Always use a gel topical anesthesia on the soft tissue, acts as a lubricant as well as anesthetic. And separate the teeth with a soft flexible wedge. It eases access and protects the soft tissue.”
  • “I like to use topical fluoride after IPR, trying to re-mineralize the cut enamel.”

Thanks to all of the providers who answered our survey. We hope you found something useful here.

Check out our Help Center for more helpful information on treating your patients with clear aligners and don't miss our upcoming advanced training webinar on IPR or our advanced training series of webinars on various topics related to clear aligner treatment.

Until next time…

Tech tip: FAQ about IPR

We sent out a survey recently asking doctors for their questions about IPR.

DrMah.jpegIn this week's tip, we've consulted with our Chief Technology Officer, Dr. James Mah, to get answers to your questions.

IPR and the treatment setup

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 for your patient, but those recommendations are never absolute. It’s up to you to make any necessary changes to customize an ideal treatment plan for each individual patient.

We can adjust all preferences related to IPR (which teeth, when and how, no IPR, expansion, limited IPR, limited expansion, etc.) or engagers based on your specifications. Just let us know what you want when you submit your case or when you review your treatment setup.

Questions about how much IPR to perform

Why do your IPR instructions always call for 0.3 mm?

If we don’t receive specific instructions from you on the amount of IPR you want done, we will go with our default increment of 0.3 mm IPR per interproximal each step. In some situations, we may recommend smaller increments of 0.1 or 0.2 mm of IPR.

These 3 increments of space can be created predictably if the right tools are used:

  • 0.1 mm of space is predictably created with hand stripping.
  • 0.2 mm can be predictably created with a single-sided diamond disc.
  • 0.3 mm can be predictably created with a double-sided diamond disc.

Doing any more than 0.3 mm of IPR at once to one interproximal is prone to problems. We usually recommend IPR in 0.3 mm increments to account for potential accumulated errors, such as:

  • When IPR is not performed correctly, the diamond disc can flex and create a “V” shape space which appears to be larger than it actually is. 
  • Hand stripping requires some force applied to the strip towards the tooth that needs reduction.  This force will sometimes move the teeth, which will make the space bigger. This space makes it look like the required tooth reduction occurred, when in fact it did not. Instead the teeth just shifted around to create space. When the aligners are put on the teeth, the space will be smaller than what is needed. 
  • A similar problem also happens when doctors force an IPR gauge into a space. They may think there is proper amount of reduction when all they really did was just move the teeth around.

Is it better to do IPR up to a point to correct rotations or to flare out to the labial?

This depends on the patient and the specific teeth. Clinician and patient preferences play a key role in determining the course of treatment. The treatment setup is your treatment plan and you are at liberty to make specific requests related to your individual patient.

How do I know when to do more or less IPR than scheduled?

Again, it depends on the specific situation. When considering IPR and the patient in front of you, you must understand that you are dealing with a biological system as opposed to a manufactured part. There are anatomic, biologic and patient variations at play which produce varying results. You will need to continue to follow what is happening with the patient and oversee treatment to obtain optimum results.

Also, knowledge of dental anatomy is important. Incisors have less enamel than other teeth and do not allow for as much IPR. Intra-oral radiographs can be used to check the amount of available enamel before submitting the case or performing IPR.

How do you measure the amount of IPR?

gauges.jpgThere are a few ways to check the amount of IPR:

  • IPR gauges (such as the ones sold by ClearCorrect) are commonly used.
  • Some dentists use the thickness of the IPR strip as a gauge, knowing that it is 0.1 mm thick. If you fold the strip over, it produces a thickness of 0.2 mm and one more fold results in 0.3 mm.
  • Some dentists use the width of the disc in the same manner.

I occasionally have difficulty with angulation of cuts, overlap, rotated teeth, access, insufficient space and possible over-reduction of one approximal surface vs. another. What should I do about this?

In some situations, it may be necessary to slightly procline the teeth and improve alignment before performing IPR, so that the appropriate tooth surface is reduced. For this reason, some clinicians prefer to perform IPR over several visits.

Scenarios like this are why many doctors do not schedule IPR at the first aligner appointment. Orthodontic tooth movement results in minor tooth mobility which allows for easier IPR.

If access is an issue on posterior teeth, you can request no IPR in posterior areas when submitting your case or reviewing the treatment setup.

What do I do to get exactly the same amount of reduction along the whole interproximal space?

When performing IPR you need to make sure that the strip or disc is completely through and past the contact point, and that the strip or disc is applied uniformly during the process. One common error is excessive tooth reduction above the contact point, leading to a “V” shaped interproximal gap.

The goal of IPR is to reduce tooth size while maintaining the original morphology of the teeth. In other words, smaller contact points between incisors should remain as such and not be flattened into broad ones. If in doubt, it is easier to carefully go slower with a strip than it is with a rotary disc.

Tight contacts make it difficult to perform IPR and for this reason, some clinicians prefer to start moving the teeth and take advantage of the associated tooth mobility before performing IPR. Another option is to start the IPR with a strip to overcome the tight initial contact and subsequently use the burr or disc.

Do you keep track with the total amount of IPR being performed throughout a case? My only concern is that at times it seems IPR is being done on the same teeth, and I worry about the patient having sensitivity due to loss of enamel.

Screen_Shot_2016-03-11_at_11.55.21_AM.pngClearCorrect represents the amounts and locations of recommended IPR on the treatment plan and treatment setup.

Our technicians usually won't recommend more than 0.3 mm IPR mesial of the canines, or more than 0.6 mm IPR distal of the canines and mesial of the first molars, unless specifically requested by the doctor. We have found that those values are conservative enough to maintain the enamel structure and to satisfy most doctors that have concerns about reducing too much enamel.

These default values are smaller for anterior teeth, because they have less enamel than posterior teeth. These values also take into consideration how the tooth will look at the end of treatment. 0.3 mm of IPR in the anterior is only 0.15 mm on one tooth, if a double-sided diamond disc is used. 0.6 mm of IPR in the posterior is only 0.3 mm on one tooth, if a double-sided diamond disc is used. Since posterior teeth can have more enamel removed, you can go back and round out the square corners by contouring after using the diamond disc.

Besides our recommendations, you should also keep track of the IPR that is actually performed on each patient. We have an IPR Tracking Chart that can help you monitor this. Each time you perform IPR it should be recorded and correlated with specific patient tooth morphology (check intraoral radiographs for thickness of enamel). 

Questions about IPR and spacing

The majority of the time you ask for a 0.3mm reduction but every time I create the 0.3mm, I end up with spaces and have to ask for more trays to close that space. Why is this?

There are several possible reasons that you may have ended up with spacing after doing IPR:

  1. Patient non-compliance.
  2. Teeth can shift unpredictably in treatment. Always be aware of this and only do IPR when it appears necessary, using the treatment plan amounts as a guideline. Your technical expertise and judgment takes precedence over any IPR recommendations.
  3. Technicians are working with digital images vs. the actual patients, so the instructions are an imperfect estimate of the amount of IPR that will actually be needed.
  4. Space closure in deep/heavy bite patients is difficult.
  5. Problems in impressions can result in inaccurate digital images.
  6. More than the required amount of IPR may have been erroneously performed.

Before performing IPR at any stage of treatment, you should check the patient’s mouth to see if treatment has been progressing as planned.

Interproximal contacts should be checked with dental floss at every visit and if the contact is not closing, you can request a digital power chain to close residual spaces.

What if I'm sure I opened the space to the prescribed amount, and when I get a notation to check for closed contacts, it's still open? If patient compliance is not the issue, should we go on to the next step, or try the current aligner for a longer period?

If patient cooperation and aligner fit are not issues, continue with treatment. The periodontal tissues are still remodeling and the residual gap may close later in treatment. Check the contact often and if it remains after alignment is achieved, request a digital power chain to close up residual spaces. 

I am concerned about creating a narrower interproximal space with less space for gingival tissue on some teeth. I still don't find any of the methods to do IPR perfect. They all present risks of iatrogenia and don't allow us to preserve the ideal tooth anatomy.

Generally interproximal tissues will remodel to accommodate the new tooth positions and there will not be any gingival excess. However, in some situations, such as the maxillary midline, this may be an issue requiring gingivectomy. 

However, these issues are all according to your preference. You can specify less IPR or no IPR when you submit the case or evaluate the treatment setup.

The hand system wears out pretty quickly and doesn't always create enough space. Some teeth can be stubborn to move and need more space, especially when the teeth are really crowded. What do I do when this happens?

This could be the result of clinical technique. Reviewing the different IPR techniques might be helpful. It could also be affected by the choice of which strip to use (course/medium/fine). These variables should be considered when performing IPR.

Questions about contouring and IPR

How do I create a natural contour instead of just a flat side?

When contouring, knowing the various IPR techniques available to you and using the one most applicable for the case at hand is important to achieve the desired result. Using hand strips after use of a diamond disc can help with rounding out some corners.

It also may be necessary to slightly procline the teeth and improve alignment before performing IPR so that the appropriate tooth surface is reduced, and then perform IPR over several visits.

General concerns about performing IPR

I get worried about the accuracy of the proposed design.

This is why it is important to see patients on a regular basis to oversee their treatment progression. Additionally, this is a concern of many doctors when first performing IPR. With more cases, treatment, and experience, this concern fades.

I find using diamond saws very scary. It’s easy to create a bloody mess in a blink of an eye. The patients really dislike the sound of the diamond blade hacking away at their dentition. It takes a lot of effort to even start the pass thru. The feel of grit and the taste of blood make them want to run.

Knowing the various IPR techniques available to you and using the one most applicable for the case at hand is important in scenarios where you have a nervous or scared patient. There are multiple available techniques for IPR (manual strips, discs) that doctors can choose from. Dentists have varying levels of comfort with each system. The choice to perform IPR or not is entirely up to you. You can always make custom requests regarding IPR when you submit your case or review the treatment setup.

How do I reassure my patient I'm not hurting or damaging the teeth when I do IPR?

Discuss enamel thickness and dental anatomy with the patient. You can let the patient know that occlusal enamel reduction through everyday chewing is a normal occurance that happens as the patient gets older. If this is a significant issue for the patient, one alternative is arch expansion to reduce or eliminate IPR. However, there are also compromises and risks involved in arch expansion.

I would like to know more about when it is appropriate to do a little unscheduled IPR to help prevent teeth from getting off track.

During every visit you can check for excessively tight contacts with dental floss. If you find that tight contacts are an issue, you can perform a little hand stripping to help keep treatment from going off track.

Should the IPR gauge fit tightly or passively?

It should be fairly passive as a tight fit will result in compression of the PDL and natural tooth mobility may be confused with available space.

We hope you found this information helpful! There's lots more where this came from—check out our Help Center, which is filled with useful information for treating your patients with clear aligners.

Also, don't miss our upcoming advanced training webinar on IPR or our advanced training series of webinars on various topics related to clear aligner treatment.

Until next time…

Bite registrations are now optional

No bite registrationThat's right, you can now submit a case with just upper & lower impressions—no bite registration necessary. (Of course, we love intraoral scans, too.)

Why the change? We've developed new software that 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. Going forward, maximum intercuspation will be our default alignment technique for all cases, even if we receive a bite registration.

There may still be a few scenarios where the bite registration is preferable (for instance, when the patient has a posterior open bite).

If you want us to base the occlusion on a bite registration instead of maximum intercuspation, please let us know in the instructions when you submit the case.

As always, you're in charge.

If you have a case that's been held up waiting for a bite registration, we'll take it off hold and you should receive a treatment setup soon.

Until next time…

Tech Tip: Using IPR to avoid case revisions

This tech tip is an oldie, but a goodie.

Sending in a case revision before doing some troubleshooting can waste money and chair time. We see a lot of case revisions submitted when unpredictable tooth movements (such as extrusions and rotations) just aren't happening. Teeth need space to complete any type of movement, and when they don't have enough, it can cause tracking or fitting issues. These tight contacts are common and can appear at any time in treatment, due to the nature of teeth and the patient's physiology.

Even if you follow the treatment plan to a T, and the patient is completely compliant, you may still need to perform IPR.

You can avoid submitting an unnecessary case revision by using these IPR techniques:

  • Always check for tight contacts before submitting a case revision. You can easily alleviate tight contacts by hand stripping, as demonstrated in our IPR tutorial video.
  • Take IPR into your own hands! The recommended amounts of IPR in the treatment setup and treatment plan are for guidance only. You are the doctor, and are the one ultimately treating the patient. Small amounts of unscheduled IPR can get treatment back on track much quicker than submitting a lengthy case revision.
  • Use your good sense -- don't perform IPR in a spot where there's already space, even if it's recommended on the treatment plan. Too late? Don't worry, it's an easy fix. At the end of treatment, the spaces caused by doing too much IPR can be closed with a digital power chain in a refinement.
  • If you still have questions, we have articles in our Help Center dedicated to performing IPR and troubleshooting other related issues. Or, you can alway contact a knowledgeable support rep; they will help you review your patient's treatment so you can decide what to do next.

We hope you found this information useful!

Also, don't miss our upcoming advanced training webinar on IPR or our advanced training series of webinars on various topics related to clear aligner treatment.

Until next time...

Carestream Dental announces NEW 3600 Intraoral Scanner

Dentistry Today recently sat down with Dr. Ed Shellard to talk all about the new CS 3600 intraoral scanner from Carestream Dental. 

Tech Tip: Tight Contacts

What are tight contacts?

Tight contacts exist when there is tension between two teeth and it is undetected by impressions and 3D models. 

Here's an example of tight contacts:

0.3mm of IPR is requested between teeth 8 & 9, but there is tension (hidden pressure) between 9 &10.  When space was created with 0.3mm of IPR, the pressure was released between 9 & 10 now creating normal contact levels since tooth number 9 has been given space to move over. This means depending on how much tension was between 9 & 10, the IPR space is now smaller, 0.2 or 0.1mm, but still not the amount required by the treatment plan.

Causes

Tight contacts between teeth exist naturally due to the patient's dentition (crowding in the arch) which will then cause the teeth to become active (spring loaded) once space is created during orthodontic treatment.

One of the consequences of tight contacts is that the planned treatment may go off track. Or in the case of the last aligner, you may still need some slight movement to get them into their final position.

Solutions

How to check if you have tight contacts

When flossing between teeth if the floss has a hard time popping in and out then you know that you have a tight contact. (If the floss pops in and out easily then this is light to moderate contact.) 

What to do with tight contacts

When you have tight contacts, you do not necessarily need to request a case revision, which could be lengthy and delay treatment. Try the following actions:

  • Floss between the suspect teeth (areas of misalignment) to check for tight contacts as described above.
  • If tight contact exists, you can do some  hand stripping to create approximately 0.1mm of IPR. 
  • If there are no tight contacts (but there is some misalignment), you can still do a little IPR (0.1mm) to help create some needed space.
  • If you have tried the above, and feel you've created sufficient space, but still have misalignment, at this point you may need to submit a revision.

Note: IPR is done at your discretion. We advise doing hand stripping which creates 0.1mm of space. If you do 0.1mm of IPR at a time, any excess space created by additional hand stripping (not on treatment plan), will be fairly easy to close at the end of treatment with a revision by requesting a digital power chain.