Interview: Dr. Ken Fischer shares his thoughts on ClearCorrect

Last time we interviewed Dr. Fischer, we asked if we could film him at his practice in Orange County, CA. This time, he tracked us down at this year’s AAO Annual Session to answer some frequently asked questions about ClearCorrect. Here’s what he had to say:

Thanks Dr. Fischer!

Early voting for the 2016 Townie Choice Awards is open!

Voting’s pretty neat. It takes Americans’ most treasured right—shouting opinions at strangers—and makes it both civilized and offi­cial.

But sometimes voting is hard—you‘ll have some tough decisions to make in November.

Fortunately, this summer, the correct choice is clear. In the Townie Choice Awards, there’s only one affordable, friendly, and fast candidate who makes quality aligners right here in the USA.

If you complete your 2016 Townie Choice Awards ballot by July 17th, Dentaltown will enter you to win:

•              Bose Soundlink Bluetooth Speaker

•              FitBit Blaze Watch

•              $500 Amazon Gift Card

•              Tuition to the 15th annual Townie Meeting

PLUS! You would be featured on the cover of December 2016 issue of Dentaltown Magazine and you'll win $1000!

Choosing candidates in other 2016 elections might be hard….but for the Townies, the choice is clear.

Vote Today!

ClearCorrect Announces Dr. Ken Fischer as New Clinical Advisor

ROUND ROCK, TX--(Marketwired – June 29, 2016) - ClearCorrect, LLC announced today the addition of orthodontist Dr. Ken Fischer, DDS as its new Clinical Advisor. Dr. Fischer brings with him over 40 years of orthodontic experience.

“As a seasoned clinician with years of experience in treating patients, Dr. Fischer complements and brings a wealth of knowledge and experience to our team,” said Dr. James Mah, ClearCorrect CTO. “He is a great presenter and provides step-by-step approaches to aligner therapy. Dr. Fischer’s emphasis on treatment efficiency and practicality will be appreciated by all ClearCorrect providers.”

Dr. Fischer currently owns an orthodontic practice in Villa Park, California. He has been an active and well-respected member of several dental organizations, including the American Association of Orthodontists, Pacific Coast Society of Orthodontists, California Association of Orthodontists, American Dental Association, California Dental Association, Orange County Dental Society, and American Academy of Forensic Sciences.

In addition to over 16 years of clear aligner experience, Dr. Fischer has authored numerous articles, guest-lectured at UCLA, and assisted the Orange County Sheriff – Coroner Department as a forensic odontologist and expert witness.

Dr. Fischer became a ClearCorrect provider in 2013. Since then, he has spoken at various dental meetings and presented numerous webinars for ClearCorrect. Regarding his new position, Dr. Fischer said, “After 41 years of continuous clinical practice I am anxious to share my experience and knowledge with a growing company that is already making significant contributions to our orthodontic profession.”

“We’re thrilled to have such an accomplished and experienced advisor on hand,” said ClearCorrect CEO Jarrett Pumphrey. “We’ve always thrived on feedback from our providers, so having Dr. Fischer’s perspective and expertise will be a tremendous benefit to the betterment and development of our products and services.”

Tech Tip: Providers offer impression tips & tricks

We recently asked some of our providers to share their tips & tricks for taking impressions.

Nothing here should be taken as official advice or recommendation from ClearCorrect or it's employees. It's up to you to use your professional judgement on what is best for you and your patients.

Here are some pearls of wisdom a few of our providers wanted to share.

Tips & tricks on impression technique

  • "Put putty in a good fitting tray, put plastic (like saran wrap) on putty, put in mouth and then when set, remove plastic and use light body syringe around teeth and put back in mouth until set. The putty is like a custom tray."
  • "Dry off the teeth with gauze first, and make sure the tray fits passively over the entire dentition."
  • "Don’t overseat the tray to the point where it contacts the teeth. It will cause a perforation in the impression material."
  • "I have the assistant dry the teeth completely with a 2x2 piece of gauze, prior to placing tray in mouth. I load most of the tray with a layer of putty or heavy body, and a thin layer of light body PVS, then quickly put a thin layer of light body directly on the teeth, especially on the facial of the anteriors. I make sure that the lip is retracted to avoid trapping air."
  • "Dry the mouth and begin from the distal of the most posterior tooth, and concentrate more on lingual of lower and buccal of upper."
  • "I use a universal body straight out of the cartridge intra-orally and in the tray. I place material via the cartridge over all teeth and add extra around and in the buccal space of the most posterior tooth bilaterally."
  • "Be sure to use adequate materials."
  • "Place light body on all surfaces of teeth to be included in the treatment, then place the heavy body over it."
  • "I prefer to let the putty set a little before I put the PVS wash in. This prevents my pushing through to the putty and/or the trays."
  • "I do a putty/wash technique. The trick though is to pop in the putty impression first, pop it out in 12 seconds or so, fill the wash into the putty, and reseat while both are soft and let them solidify in tandem…no distortion of trim needed."
  • "Put a thin layer of wash on top of heavy body at the occlusal and incisal position prior to seating. Have patient rinse mouth with mouthwash prior to impression to cut surface tension. May need to prophy first to remove heavy plaque or food from between teeth."
  • "Place a strip of red rope wax across the posterior border of the upper impression tray to limit the flow of the impression material posteriorly."
  • "I have a lot of success with 3M Position & trays. You can use a border molding/wash technique by systematically adding material and the design of the tray helps prevent overflow which reduces the gag reflex."
  • "Having the patient bite slightly helps if they can."

Tips on tools for taking impressions

  • "Use OptraGate retractors."
  • "Use cheek retractors."
  • "Use a very stiff, fast set, VBS material in small amount at end of the tray as a separate first step to stabilize tray for final impression and to prevent material from running past tray and gagging the patient."
  • "I now use different viscosity material for my orthodontic impressions than I use for crown & bridge impressions. My assistant fills the tray with a syringeable monophase PVS while I dry the teeth and syringe a light body PVS on the occlusal surface. I then place a thin layer of the light body PVS over the monophase in the tray, and seat. Works every time!"
  • "I use wax in the posterior of the trays to build a “dam” on the upper to prevent pulls or running of material. Both putty/wash and heavy body wash works well."
  • "I typically do a light body wash over a medium body. That usually helps pick up the sulci accurately."
  • "I use a fast set (90 second) from Parkell to minimize patient gagging and discomfort."
  • I use Panasil Tray Fast Heavy and Panasil Initial Contact X-Light."

General tips on taking impressions

  • "Practice – technique is more important than materials."
  • "Prepare patient that it is not the most comfortable experience but it will be over quickly and cooperation is needed to ensure you only have to do each arch once."
  • "Take your time."
  • "Patient compliance is very important."

Tips about scanners

  • "The CEREC Omnicam is very intuitive."
  • "Intraoral scanner is the way to go!!"
  • "Getting dental impressions is easy with my OmiCam!"

We hope you found some of the information helpful!

Until next time...

Tech Tip: Information on impressions

In case you missed it, in our last tech tip, we walked you through how to locate an occlusal view of your original PVS impression scans in the doctor's portal.

On that same topic, we recently did a survey to find out what questions you had about impressions and the most common question was:

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.

And in case you haven't seen these, we have an array of articles in our Help Center, covering various impression topics. Whatever your questions are, these articles likely have the answers:

We hope you found this information helpful! Keep an eye out for our upcoming article on some provider offered tips & tricks on taking impressions.

Until next time...

USPTO determines Align’s claims probably invalid

We got some great news from the USPTO!

But first, let me explain. No, there is too much. Let me sum up:

Last year, ClearCorrect petitioned for ex parte reexaminations , asking the United States Patent and Trademark Office (USPTO) to review several of Align’s patents.* These ex parte reexaminations are currently underway. So far, the USPTO has indicated agreement with ClearCorrect's position that all 75 claims of the patents in question are invalid.

Meanwhile, our legal team has also petitioned for an inter partes review of Align Technology’s patent #6,699,037 (’037) with the USPTO Patent Trial & Appeal Board. (Align has not accused ClearCorrect of infringing this patent, but it contains claims similar to those in other patents that Align has asserted against us.)

An inter partes review occurs between two parties, with the USPTO judges acting as examiners. This approach allowed ClearCorrect’s legal team to directly present key examples of “prior art” that predate Align’s in an effort to question ‘037’s patentability.

Phew! Here’s the “great news” part:

On May 23rd, 2016, the Patent Trial & Appeal Board accepted ClearCorrect’s petition and decided to institute a trial to reexamine key claims of the ’037 patent. The board determined that there is a “reasonable likelihood that ClearCorrect would prevail in showing that claims 1, 2, 9, and 10 of the ’037 patent are unpatentable.” (Over 70% of challenges accepted by the board result in cancellation of patent claims.)

Scott A. McKeown (a partner with the Washington, DC law firm Oblon, McClelland, Maier & Neustadt), who is leading our effort at the patent office, explains:

“We now have the board's feedback on our key ground of invalidity, which is presented in the inter partes review. We now know there is strong likelihood for a positive outcome for our pending reexamination proceedings. This is exactly what we hoped to accomplish when we filed the ’037 review.”

Cool! So what’s going on now?

We are still awaiting final decisions in the ex parte reexaminations. Ex parte reexaminations tend to take one to two years to resolve. Inter parte reviews can be faster—we expect a final decision in this case within a year. Align’s one remaining lawsuit against us is still stayed as the ITC deliberates whether they want to try their appeal again with the Supreme Court.

The board’s decision to review this patent is the latest in a series of legal victories for ClearCorrect. It is also indicative of reasoning that should also apply to the remaining lawsuit with Align. There is little reason to think that Align’s claims will fare better outside of the USPTO, since the same or similar patents will be cited. Align’s chances for success are rapidly diminishing as their claims are repudiated at every turn.

High-five, Legal. You rock.

*U.S. patents 5,975,893; 6,217,325; 6,398,548; 6,626,666; 6,722,880; 7,125,248; 7,578,674; and 8,070,487.

Tech Tip: Notes from your Technician

You may have noticed notes from your technician regarding your treatment setup. These notes can be about the case type, your prescription or the quality of your impressions. These notes or comments do not always require a response.

Screen_Shot_2016-05-27_at_3.49.26_PM.png

If you have a question or would like to respond to the note, you can click DISAPPROVE and there will be a field for you to enter your response.

When disapproving a treatment setup, providing your technician with the following information will give them a clear picture of the problem and what you want changed, resulting in a quick turnaround on your setup.

  1. Tell your technician what you don't like about the setup.
  2. Tell your technician what angle you are viewing the setup from.
  3. Give your technician simple instructions on how you would like any issues to be corrected.

Screen_Shot_2016-05-27_at_3.49.48_PM.png

The other type of note you might receive from your technician is usually a question on your prescription or materials before they can provide your treatment setup. In this situation, you will see the action item below, with the technician's notes and a field for you to reply.

Screen_Shot_2016-05-27_at_4.09.38_PM.png

You may also receive emails (daily summary emails) notifying you that there is a note from your technician. You can click on the case in the email and it will ask you to log in to the doctor's portal where you will see the case and notes from the technician to reply.

Screen_Shot_2016-05-27_at_4.12.50_PM.png

Viewing your original impression scans

The note from your technician may sometimes be about your impressions. If you would like to review your original impression scans, you can scroll down from the notification box and in the History section of the case, where you will see a title "Upper impression, lower impression received" along with the date it was receieved and an icon of the impression.

Each of the icons in the history can be clicked on, opened and viewed. (This is also how you can access your invoice, photos and the treatment prescription for the case.)

Screen_Shot_2016-05-27_at_4.13.53_PM.png

We hope this information is useful to you when you're reviewing and approving your treatment setups!

Until next time...

Now offering new merchandise for taking photos

We’re happy to announce a new addition to our online store! Novus Dental Supplies' Full Arch Intraoral Mirror and a variety of cheek retractors.

These items are recommended for use when taking the photos required when submitting a case. You can pre-order these new items and save 10%. Enter promo code: PHOTO when ordering. The pre-order 10% off discount is for the new Novus Dental Supplies merchandise only and is only available until June 24th.

10.png

Here is the selection of new photo merchandise you can choose from:

Full Arch Intraoral Mirror

 Intraoral_Mirror.jpg

The Full Arch Intraoral Dental Mirror by Novus Dental is designed to provide the highest quality digital photo in dentistry. The mirror allows you to see a clear, accurate picture of both the maxillary and mandibular arch of your patient's mouth in two simple photos.

The most unique feature is the lightweight, easy to use design. While most dental mirrors only capture half of an arch in a single photo, the Full Arch Intraoral dental Mirror is sized appropriately to capture the full arch of the mouth, including the third molars, while sitting comfortably on the opposing arch.

The stainless steel base with double chrome plating provides a clear image while preventing breakage and discoloration during steam sterilization thus making the dental mirror significantly more durable than it's rhodium counterparts.

All the patented design features can be found in this Specification Sheet.

Instructions on use and cleaning the mirror can be found here.

We’re offering this product for $65.00 with an additional 10% off with the promo code.

Cheek Retractors - Mouth Widers and Cheek Retractors with Handles

Cheek_retractors_mouth_widers.jpg

Cheek_retractors_with_handles.jpg

Whichever style you prefer, these cheek retractors are great for pulling back cheeks and lips when taking photos. The retractors are made of a polycarbonate plastic material and are fully autoclavable. It's recommended that they be cold sterilized between uses.

We're offering the retractors each in two different sizes, Adult and Pedo.

Each of the cheek retractors are $13.00 with an additional 10% off with the promo code.

These new merchandise items are being offered at these discounted prices for a limited time. Take advantage of these pre-order prices as they will only be available until June 24th.

Click to pre-order!

Estimated shipment - June 24th

Tech Tip: All about scanners

Making accurate dental impressions is easily the most essential part of submitting a case. There are many different options out there for capturing dental impressions, from traditional impressions to the wide variety of intraoral scanners available on the market today.

3-D technology has had a significant impact on dentistry in the last 20 years, and it is only expected to increase in the coming years. More and more doctors are moving over to intraoral scanners.

We thought that a tip covering intraoral scanning with ClearCorrect might be helpful, whether you already use an intraoral scanner or if you're considering one.

Intraoral scanners

A study from 2014 found that the use of intraoral scanners could significantly accelerate the work flow of making impressions.

Some benefits of using an intraoral scanner include:

  • More comfortable for patients than conventional impressions
  • Save costs on impression materials
  • No shipping hassles
  • Higher accuracy than traditional impressions
  • Fewer errors resulting in having to re-impress
  • Facilitates sending scans to ClearCorrect electronically, resulting in a faster turnaround

ClearCorrect accepts records from most intraoral scanners currently on the market.

Scanners_1.png

With the wide variety of intraoral scanners available, selecting the best intraoral scanner for you really comes down to your preferences. Some things you might want to consider when choosing a scanner:

  • Is the scanner portable?
  • Is the scanner light and easy to use?
  • Will the scanning experience be comfortable for patients?
  • Is there a cost for image export and storage?
  • Is the software for the scanner compatible with your practice management software?

Submitting a case to ClearCorrect with scanners

You can upload scan files from any intraoral scanner to ClearComm as long as the file is in STL format. (STL is an open, industry-standard file format that can be exported by most popular scanners.) Export your STL files from your scanner to your computer, and then upload those files just like your photos when you submit a case online, or on the case page after submitting.

Submit_a_case_8.png

STL files are not necessary if your scanner has the option to select ClearCorrect as your dental lab and upload scans directly from the scanner. CEREC Connect and TRIOS currenty offer this option.

We provide instructions for some of the common scanners:

Model or impression scanners

We also accept scans from model or impression scanners like Motion View's Ortho Insight 3D Scanner. Whether you're using an intraoral scanner or a model or impression scanner, ClearCorrect works with your team to accept digital files enhancing productivity and quality.

Scanning tips

Here are a few tips for using scanners:

  • We strongly recommend that you visually inspect your STL files before you submit them to us. We recommend netfabb Studio Basic, which is available free for Windows, Mac, and Linux. Other STL viewing options include viewstl.com, MiniMagics and FreeCAD.
  • Some scanners output several files, but the only files we want are the upper and lower arches. The arches should be saved in separate files, with the arches oriented in occlusion.
  • Scan both arches, even if you're only treating or revising one of them. Recreating the occlusion based on one arch is prone to error. (This advice applies to PVS impressions as well.)
  • We prefer "closed shell" models, but "open shell" models are acceptable too.
  • To prevent aligners from flaring at the edges, always capture at least 3-5 millimeters of gum in the scan.
  • While bite registrations are no longer a requirement for submitting PVS impresions to ClearCorrect, this is still part of the workflow with some scanners. You can capture more accurate bite scans by including as much of the occlusion as your scanner allows.
  • We can't provide support for your scanner software, but if you have any other questions, as always, our knowledgeable support reps are here to help.

We hope you found this information useful!

Until next time…

Tech Tip: Case submission FAQs & tips from providers

In a recent survey, we asked some of our providers about any questions they might have on the topic of case submission, prescription and treatment setups. Below are some of the questions and answers. We hope you find this information helpful!

FAQ about case submission, prescription & treatment setups

Is ClearCorrect now 2 weeks for each aligner? I’m still using the 3 week method.

We did change our default wear schedule from 3 weeks to 2 weeks in 2015. At the same time, we also added the ability for you to choose your patient's wear schedule when you submit your case. With this change, you're able to request a 3-week, 2-week, or even 1-week wear schedule and you can dispense as many aligners as you see fit at each appointment. (This only applies to new cases--any cases that started on a 3-week schedule should still be on that schedule.) We recommend that most patients wear each set of aligners for at least two weeks. See our full article on aligner wear schedules.

Wear schedules can be viewed in the treatment setup and in the fine print on the treatment plan.

If a bite is no longer needed, how do we bypass this in CEREC Connect?

At this time, a bite scan is a requirement and part of the workflow when scanning with CEREC Connect. While we've made bite registrations optional, most doctors still like to take a bite scan to have as a record to compare to the bite that we provide in our treatment setup.

I understand that this system is only for anterior teeth. Is that correct?

No, ClearCorrect is an advanced system of clear aligner therapy that uses the latest digital technologies, design and clinical approaches to treat various types of malocclusion, ranging from simple to advanced extraction and surgical cases depending on the knowledge and expertise of the doctor.

What are the most common issues that cause a Limited 12 aligner case to be elevated to an Unlimited case?

When the ClearCorrect technician reads the case submission form, they try to follow all of the doctor's instructions taking into account the requested case type. However, if they can't follow both the treatment plan and case type instructions, they will prioritize the treatment plan instructions over the case type which can lead to upgrading the case to an Unlimited. If it's noted on the case submission form that the case type is a higher priority over the treatment plan, along with a note of which correction is allowed to be compromised for the case type, then our technician will follow those instructions instead of their normal protocol.

I’m not sure about the amount of trays to plan for. Maybe a guideline to selecting the right case type?

In 2015 we made a change where by default and at no charge to you, our technicians recommend a case type appropriate for the treatment you prescribe, which eliminates the need for you to choose the case type for your patient. However, if you have a preference, you can indicate it when you submit the case.

Submite_a_case_2.png

Either way, the case type won’t be final until you approve a treatment setup and pay for the case.

If you want to choose your case type, we've prepared a simple chart to help you predict which treatment option might be best for your case:

option_comparison_chart.png

Can I ask for specific sizes or shapes of attachments for the setup?

Not at this time. Engagers are an active area of research and development at ClearCorrect and elsewhere. Many variations of engager shapes have been proposed and discussed in literature and professional forums, but in practice, once the shape is thermoformed in the engager template, problems of adaptation and air gaps reduce the capability of many of these designs.

Without conclusive information and until the mentioned adaptation problems are resolved, ClearCorrect is happy to stick to the simple horizontal and vertical engagers that we've been using for the last ten years, which have proven sufficient to help with movements requiring an engager.

Fortunately, because of the way we trim our trays, our aligners are 2-4 times stronger than our competitors. This can reduce the need for engagers in many cases.

It looks like some overcorrection was built into the treatment setup. Is this correct?

Overcorrection is only added to the case per the doctor's instructions. Overcorrection can be requested at the beginning of a case when filling out the submission form, when submitting a revision or when reviewing/approving the treatment setup.

No bite turbo or bite ramps were offered, is this something that will be coming or is it even necessary with the greater gingival coverage that ClearCorrect has in their aligners?

Doctors can request lingual engagers to prevent full closure of the teeth. This is an advanced treatment technique, and should be monitored carefully. Whether a bite turbo and/or bite ramp is necessary would be determined on a case by case basis.

In cases with anterior interproximal reduction, how can I have a virtual power chain added to the end of the treatment sequence so that I have all the required aligners, including for the power chain, without having to request a revision?

When submitting the case, just ask for overcorrection with a digital power chain on the last two steps in order to get a virtual power chain without having to request a revision.

How do you determine which teeth will start the movement? (Or, phrased differently); How do you stage treatment?

We use protocols that have been developed by our Chief Technology Officer, orthodontist Dr. James Mah; ClearCorrect founder Dr. Willis J. Pumphrey; and our VP Products, Paul Dinh, CDT. These protocols are applied on a case-by-case basis by our technicians to help get the outcomes you prescribe for your patients.

Is there a process that I can tweak the final treatment setup myself?

Not at this time, though we are aware that doctors are interested in this functionality. The current process for adjusting your treatment setup is described below.

How do I make adjustments to a treatment setup?

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

Treatment_Setup-2.png

Treatment_Setup_8.png

I have difficulty with viewing the setup. It isn’t real clear to see the final result. I kind of just go on faith that it is going to look good.

At the bottom left of the setup, you'll see a timeline representing every step of the case. The starting position of the teeth is shown at the left. Steps with checkup appointments are numbered on the timeline, and the final position of the teeth is represented on the right as a retainer.

Treatment_Setup_2-1.png

To navigate between steps, you can drag the slider, click on a step, click the Previous and Next arrows, or click Play to animate the treatment from beginning to end. You can click Previous at the beginning or Next at the end of treatment to quickly toggle between views before and after treatment.

Shortcuts are available for the most common views: Upper occlusal, Lower occlusal, Right, Front, and Left. You can also rotate the model to view the teeth from any angle by clicking and dragging.

Treatment_Setup_3.png

I sometimes need help in deciding on the treatment setup.

When approving a treatment setup, it's best to begin with the end in mind - consider the whole treatment and what are the goals for that particular patient. Also, when filling out the case submission form, the more information you give the better treatment setups you'll receive.

For more information, see our recommendations for how to evaluate the treatment setup in our Help Center article on this topic.

As a “bracket man” for years, I feel that the torque movements are hard to envision. Can some support evidence or outcomes be made available to give me more confidence?

We understand that being able to see some successful outcomes is helpful. We offer a number of different case studies covering a variety of scenarios from treatment of a Class II with crowding and a deep bite, to treating an anterior open bite with clear aligners. You can check out all of our case studies in our Help Center.

Provider tips & tricks

Some of our providers offered a few tips & tricks for submitting cases. Nothing here should be taken as official advice or recommendation from ClearCorrect or its employees. It’s up to you to use your professional judgement on what is best for you and your patients.

  • "I usually let ClearCorrect dictate the course of action. I have had an extraction case that I had never done before and the ClearCorrect technician walked me through it and said that she had seen my other work and was sure that I could do this as well. It made me feel good."
  • "I look at my comprehensive diagnosis and go through in my head step-by-step what I need to correct the deficiencies."
  • "I like to avoid placing attachments at the initial stages, so that the patient can become accustomed to the appliances before making it tougher to remove them."
  • "I would recommend that all doctors finish with a digital power chain."
  • "I would overcorrect all rotations and ask for power chain to close any original spacing. My experience tells me that less engagers allow better fitting and tracking of aligners."
  • "I always leave 1mm of overjet between anteriors at completion to prevent a slight posterior open bite."

Thanks to all the providers who answered our survey!

Check out our Help Center for more helpful information on treating your patients with clear aligners.

Until next time...