Tech Tip: Best practices for taking impressions

Perhaps the most important aspect of submitting a case with ClearCorrect is making sure that you have clear, accurate impressions or intraoral scans. We thought we’d cover some of the basics on the topic of taking impressions.

From your technique to the material and trays used, there are a number of important things to keep in mind when you are taking impressions.

Best practices

  • PVS or VPS materials work best for impressions. Alginate is not acceptable 
    because it dries out and the material itself can shrink or expand depending on environmental factors.
  • Be sure to use disposable trays and not metal trays – we don’t return tray and when a metal tray is no metal trays.pngreceived, the impression has to be processed manually, which can open the door to potential issues with the aligners.
  • We recommend using heavy body and light body material. Impression techniques that used heavy body and light body seem to get the best results.
  • Performing a cleaning before taking impressions removes plaque which can make for better impressions and could reduce the amount of residual spacing at the end of treatment.
  • Dry the teeth with the air syringe to eliminate saliva bubbles interfering with the details of the impression.
  • Be sure to remove all engagers before taking impressions. When impressions areengagers not removed 4-1.png 
    taken with engagers still attached to the patient’s teeth, there is a possibility of the engager tearing the impression when removed and can cause damage to the impression.
  • One-step impression techniques seem to get the best results (but we’ll accept two-step impressions as well).
  • When applying the light body material on top of the heavy body, it is best to avoid lifting the tip of the applicator. This will help prevent bubbles from forming in the impression.
  • The most common mistake when taking impressions is removing the trays when the material hasn’t fully set.
    • timer.jpgSet a timer and make sure to follow the directions for your material exactly.
    • Discard the first inch of material that comes out of every new mixing tip.
    • We suggest waiting an additional 60-90 seconds longer than instructed before removing the trays from the patient’s mouth.
  • Another common issue with taking impressions is getting the distal of the last molars—it can be difficult to get a good impression since it’s hard to see back there.
    • Make sure that you’re using a correctly-sized tray. It should extend past the last tooth in the arch without touching the gums.
    • 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.
  • Once you’ve taken your impressions, before you send them in, take a look at the impression and check the following:
    1. good impression v2.pngMake sure you have detailed, accurate occlusal surfaces. This will ensure that the aligners will have a tight fit.
    2. Make sure all gingival margins are defined and clear. (Includes about 2mm of buccal and lingual surfaces outside gingival margin.) This will ensure enough retention points are present for effective tooth movement.
    3. Make sure that the impression material is intact. Damaged or thin impression material compromises the accuracy of the molds and resulting aligners.
    4. Check that there are no imperfections in the impression material. (Make sure there are no voids, bubbles, thin walls, shifts, double imprints, pulls or tears.) Imperfections or double imprints in the impression could affect the effectiveness of treatment with the resulting aligners.

Voids

Insufficient material creates a void in the impression, preventing us from captuing the actual tooth outline.

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Bubbles

This occurs while the impression material is being distributed, due to the tip being lifted out of the material. Pulling the tip out creates a hollow void that, when more material is distributed on top of it, creates a bubble.

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Thin walls

Thin walls are created a number of ways: insufficient material, too small trays, or the tray was pushed in too deep. The material itself captures the majority of the tooth anatomy, however the scanning process (performed at ClearCorrect) does not pick up the tray well (where the tray shows through, as in the image below), leaving that much of the tooth anatomy incomplete or distorted.

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Shifts

The tray shifted while the impression material was still setting, creating a double margin on a few teeth.

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Double imprints

When the full arch or quadrant was shifted, normally occurring during a two-step impression.

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Pulls

When the impression material starts to prematurely set before it's placed in the patient's mouth it results in a "pulled" effect around the gingival margin.

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Tears

Tears occur when the patient has extreme undercuts or black triangles which causes the impression material to lock into the interproximal and tear when removing the impression (to avoid this, use wax to block out undercuts before taking the impression).

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Following these best practices can mean the difference between receiving a good treatment setup with aligners that fit properly or having a difficult case that doesn’t track. Make sure you’re sending in good impressions for your cases and start your cases off right!

And, just as a reminder, we accept digital impressions (scans) from CERECOrmco Lythos3M True DefintionCarestreamiTero3Shape TRIOSE4D PlanScan and Motion View Ortho Insight 3D scanners.

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

Until next time…

Tech Tip: Gum recession

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Definition

Gingival (gum) recession is the process in which the margin of the gum tissue that surrounds the teeth moves apically away from the cementoenamel junction, exposing more of the tooth or the tooth’s root. Healthy, attached gingival tissue can only exist in the presence of healthy, supporting alveolar bone; when one or more of the causative factors listed below are present, gingival recession is likely to be observed.

Causes

There are a number of factors that can cause the gingival margins to recede, including:

  • Improper tooth brushing with a hard bristle toothbrush
  • Periodontal disease
  • Poor oral hygiene and plaque accumulation
  • Hereditary factors (Periodontal and Gingival Biotype)
  • Intraoral use of tobacco products
  • Clenching or teeth grinding 
  • Traumatic contact between opposing teeth
  • Teeth being moved excessively against the buccofacial cortical bone

Solution

Recession & clear aligners

Recession is rarely observed during orthodontic treatment with clear aligners, but the poorly monitored use of fixed braces and auxiliary appliances, e.g. rapid palatal expanders, can result in teeth being excessively moved buccofacially, overwhelming the thin cortical plate of alveolar bone, producing the unwanted recession.

Reducing the excessive pressure as soon as observed may stop the recession, however, once the bone is lost, it will not regenerate sufficiently to replace the lost tissue.

These are situations where gingival grafting to cover the recession may be indicated prior to orthodontic treatment. Consultation with a periodontist is suggested in the management of moderate to severe recession.

Actions to take

When the first signs of gingival recession are observed, it is imperative that the etiology be determined. Is the pathology due to:

  • soft tissue issues,
  • habits,
  • traumatic contacts,
  • or consequential tooth movement?

The initial considerations should be given to the patient’s toothbrushing technique and toothbrush, and confirmed to be in accord with the dentist’s instructions and recommendations for improving the oral hygiene regimen.

In cases where large deposits of plaque have formed, the patient should have it removed as soon as possible.

Extreme recession may need to be treated surgically with a periodontal flap repositioned to cover the exposed roots and interproximal spaces.

Harmful habits

Habitual use of pipe smoking, chewing tobacco, or other caustic agent can irritate the tissues and cause the inflammatory response that leads to potential recession and bone loss. The patient should be advised to discontinue the harmful habit.

Clenching or grinding the teeth together tightly and frequently (bruxism) may be another reason the tissue and bone succumb to the inflammatory response. Nocturnal use of a mouthguard may reduce the damaging enamel wear and associated tissue recession.

Even in the absence of this muscular hyperactivity, an isolated high or traumatic contact between two teeth somewhere in the occlusion may be the stimulant that results in the tissue and bone breakdown. An analytic equilibration to remove the traumatic contacts and balance the occlusion may help soothe the discomfort and allow the tissue to respond positively back to health.

We hope this information was helpful!

Until next time...

Photo credit: Dear Doctor, Inc.

Tech tip: ClearCorrect and wisdom teeth

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Orthodontic treatment often evokes questions about third molars, or “wisdom teeth.” Our clinical advisor, Dr. Ken Fischer, has some answers:

“What should be done with the third molars?”

Although frequently congenitally missing, the presence of those teeth, erupted or unerupted, may influence the doctor’s treatment planning. For example, if the second molar needs to be distalized or uprighted, the doctor should be aware of the third molar. If it is present, it will likely interfere with the movement of the second molar. Also, if the doctor is considering the removal of the second molar (due to its condition or position), he or she may want to consider allowing the unerupted third molar to serve as the second molar in lieu of being extracted.

“What is the prognosis for retained unerupted third molars—extract or not?”

One must consider whether removing the retained molars is preventive (to reduce future negative circumstances) or therapeutic (correcting an existing problem).

“When should third molars be removed?”

Every patient is different and assessed individually, however there are some general guidelines that may be followed. One should justify the removal of asystematic teeth, including the wisdom teeth. A third molar can be considered for extraction if:

  1. it is in decay,
  2. it is infected,
  3. there is a pathology associated with it such as a dentigerous cyst, or
  4. its impacted position is threatening the health of the second molar.

Some dentists believe third molars should be extracted proactively during early adolescence if it is determined that there will be a very low probability there will be enough room for the third to erupt.

Third molar extraction

The most commonly seen scenario for third molar extraction is when the mesially-inclined wisdom tooth is impacted (unable to erupt normally) and placing pressure against the distal surface of the second molar. This condition may cause damage to the second molar and/or a dentigerous cyst may develop around the impacted tooth causing extensive damage to the surrounding bone. Even though impacted, if that tooth is not threatening the health of the adjacent teeth or surrounding bone, there is no requirement for extraction.

Using accepted techniques or experience-based judgement to evaluate the potential for the developing wisdom tooth to not erupt, may lead to a reasoned decision to remove a third molar preventively. If this decision is made, surgically extracting the tooth or teeth before extensive root growth usually results in a less negative abnormality than performing the procedure after full root development occurs.

Treatment plans that include distalizing the second molars should consider the presence and position of the third molar to evaluate if that tooth will limit the distalization. Certain treatment plans may want to replace a missing or defective second molar with the eruption and advancement of the third molar.

Special attention must be given to third molars when clear aligners are used. Even when they have erupted, they rarely display enough of the supra-gingival crown for an aligner to sufficiently cover the crown for optimal adaptation and retention, often causing a poor fit. If the wisdom tooth is erupting during aligner wear, it may interfere with the distogingival margin of the aligner, preventing it from fitting properly.

Many still believe the old adage that eruption of the wisdom teeth causes the lower anterior teeth to crowd. Contemporary research in the literature has convinced many of us that adage should no longer be supported. Late adolescent growth of the mandible forcing the lower anteriors against the lingual of the upper anteriors, causing the lowers to crowd, is a more evidence-based explanation for the observed shifting of the lower incisors.

We hope you find this information useful! Check out our Help Center for more articles like this on the topic of clear aligner treatment.

Until next time...

Tech Tip: ClearComm - ClearCorrect's case management tool

ClearComm is ClearCorrect's online case management tool located at dr.clearcorrect.com. It's also sometimes referred to as the doctor's portal. In this article, we'll introduce you to the main areas of ClearComm so you can find important information for managing your cases.

Manage cases

When you log in, ClearComm starts by showing the action needed tab on the Manage cases page, which lists any cases that require your immediate attention.

action needed tab.png

Items under the action needed tab might include incomplete submissions, records that haven't been received yet, or treatment setups that are waiting to be evaluated.

You can also choose to view cases in progress and cases that have been closed.

Clicking on any case will take you to its case page, where you can review the history of the case and any actions available to you regarding that case.

Case page

The case page displays everything you need to to manage a case and keep it running smoothly.

ClearComm new 2.png

Case information

The current status and available actions for the case show up as action items at the top of the case page. Some action items include:

  • Submission incomplete You've started an online submission for this case, but haven't finished submitting it yet.

ClearComm new 3.png

  • Waiting for intraoral scans or impressions (or other records) We're waiting to receive records from you to continue with the case. Digital files can be uploaded by clicking Upload, and physical records can be sent by clicking Ship to generate a shipping label.

ClearComm new 4.png

  • Treatment setup in production We've received all required records, and we're staging your case.

ClearComm new 12.png

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  • Issues with submission This often reflects distorted or incomplete impressions or scans.

ClearComm new 10.png

Once the case is in progress, you'll see the status and estimated arrival date of the next phase:

ClearComm new 6.png

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If you need to revise the case, click the revise button. (See full article on how to request a revision.) Once the final scheduled phase has shipped, you'll see an option to request a final retainer:

ClearComm new 9.png

Case history

The case page also includes the history for the case. This includes icons you can click to view many of the records for the case including treatment setups, images of the impressions or scans submitted, photos, x-rays, forms, and invoices.

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Submit a case

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Here's where you can submit your cases. (See full details in our article on submitting a case.) Payment is not required until you approve the treatment setup.

Uploading or shipping records 

If you don't upload records when you submit your prescription, you'll see a notification indicating that we are waiting for your records.

ClearComm new 4-1.png

Click upload to upload files or ship to create a shipping label.

ClearComm new 15.png

Once you've created your shipping label, you'll have the option to re-print it if needed until it is used. (Shipping labels cannot be used again for a second shipment. The reprint option is intended for a lost or unused label.)

ClearComm new 16.png

My Account

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You can edit your name, password, credit card information, email notifications and email addresses in the My Account section.

To update other practice information, please contact support.

Sidebar

In the sidebar, which is available on any page, you have easy access to your cases, the link for submitting a case, a link for treatment setups that need approval and ClearCorrect's online Help Center which is filled with useful articles on the topic of clear aligner treatment. You can also access ClearCorrect's online store where you can purchase useful tools for treating clear aligner patients.  

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We hope you found this information helpful!

Until next time...

2017 Event and Trade Show Calendar

Here's a look at the shows we're attending this year.

ClearCorrect's 2017 Calendar of Events:

Yankee Dental Congress Booth #1540 Boston, MA - Jan. 26-28

AAO Midwinter Booth #305 Fort Lauderdale, Florida Feb. 10-11

Chicago Midwinter Booth #4247 Chicago, Illinois Feb. 23-25

PCSO Spring Booth #407 Scottsdale, Arizona March 2-4

ADSO Orlando, Florida March 7-10

Pacific Dental Conference Booth #1704 Vancouver, British Columbia March 9-11

SIDO Spring Booth #12 Florence, Italy March 17-18

IDS Booth #60 Cologne, Germany March 21-25

Hinman Booth #11 Atlanta, Georgia March 23-25

AAO Annual Session Booth #2915 San Diego, California April 21-25

Smile Source Booth #TBD Nashville, Tennessee May 4-6

ODA Ontario Dental Association Booth #124 Toronto, Ontario May 4-6

CDA California Dental Association Booth #349 Anaheim, California May 4-6

The Dentistry Show Booth #H20 Birmingham, England May 12-13

ADC Australian Dental Congress Booth #171 Melbourne, Australia May 17-21

EOS European Orthodontic Society Booth #28 Montreux, Switzerland June 5-10

FNDC Booth #827 Orlando, Florida June 22-24

GORP Graduate Orthodontic Residents Program Booth #52 Cleveland, Ohio August 3–6, 

CDA California Dental Association Booth #1628 San Francisco, California August 24-26

RMSO Rocky Mountain Society of Orthodontists Booth #109 Salt Lake City, Utah Sept. 8-9

CAO Canadian Association of Orthodontists Booth #307 Toronto, Ontario Sept. 15-16

Dentsply Sirona World Booth #812 Las Vegas, Nevada Sept. 14-16

AOS Booth #28 Clearwater, Florida Sept. 14-16

SWSO/MSO/GLAO Booth #205 New Orleans, Louisiana Sept. 14-17

SAO Southern Association of Orthodontists Booth #200 Tampa, Florida Oct. 5-8

PCSO Pacific Coast Society of Orthodontists Booth #407 Reno, Nevada Oct. 11-15

ADA American Dental Association Booth #2819 Atlanta, Georgia Oct. 19-21

SIDO Booth #34 Rome, Italy Oct. 19-21

MKS Booth #28 Dallas, Texas Oct. 27-28

MASO Mid-Atlantic Society of Orthodontists Booth #9 Southhampton, Bermuda Nov. 2-5

NESO North Eastern Society of Orthodontists Booth #215 Boston, Massachusetts Nov. 9-12

Greater New York Dental Meeting Booth #5034 New York, New York Nov. 24-29

Tech Tip: Anticipating potential problems in clear aligner therapy

It’s important to anticipate potential problems before you submit your case and decide what approach you want to take to address them.

Most cases are treatable with clear aligners. However, there are some issues you should keep an eye out for, including:

You can let us know how you want to address any of these issues in the Additional Instructions section when submitting a case.

Think about your treatment goals before you submit your case. Keeping the end in mind is the best way to get the outcome you want for your patient. Providing more information will lead to better treatment setups. We're happy to work with you to get the treatment plan you desire.

You can find more articles on this topic in our Help Center in the Prescribing a Case section.

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

Until next time…

Tech Tip: Submitting a case with a smartphone

Did you know that you can submit a case with your smartphone? Some doctors prefer this option if they're taking the required photos using a phone.

Here's the process:

1. Login to the Doctor's Portal through Safari or other web browser on your smartphone

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2. Sign in and click "Submit a case" or click on the incomplete case submission (if completeting a case submission already started)

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3. Go through the prompts for submitting a case

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4. When on the step for uploading photos, click on "Select photos" and choose photos to upload from phone

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5. Finish remaining steps for submitting the case

The treatment setup for the case should arrive within a few days of submitting your case. The setup for the case can also be viewed and shared on your smartphone.

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We hope you found this information helpful!

Until next time...

Patient Financing through beWell by FTL Finance

We're very excited to announce that patient financing is now available for ClearCorrect through beWell by FTL Finance!

We spent some time looking at all the available options for patient financing and through careful consideration we're happy to partner with beWell by FTL Finance. We've negotiated to get you and your patients one of the best deals available for patient financing on the market. 

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beWell supports both the provider and the patient with competitive financing products: 

  • Two program options with no provider fees
  • 20-30% more approvals
  • A dedicated account manager to guide you every step of the way
  • An easy patient application process
  • No "gotcha" interest rates or prepayment penalties

Financing can be an important tool to profitably grow your practice. beWell financing compliments your existing financing options to support your success.

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You can find more information at bewellftl.com or by calling (855) 896-5333.

Registration usually costs $75, but ClearCorrect providers can register for free using the promo code CCFREE.

We hope you're as excited as we are about this incredible new option available for ClearCorrect providers!

Until next time…

Free Marketing Templates

Did you know that ClearCorrect offers free templates for marketing to your patients?

Patient email/mailer templates

Download these free email or mailer templates that you can send to your customer data base. These are designed so that you can personalize and edit them to your satisfaction. The less costly option would be sending the template via email with the added perk of watching your inbox fill up with appointment requests. We have designed a couple options for you, download just one or all of them if you like!

Here are some simple instructions for downloading:

  • Click on the image below to download a copy of the template
  • Open the template as a Microsoft Word Document (it should do this automatically)
  • Edit the template to your satisfaction; name, practice information, special offers, etc.
  • Copy and paste the Word document into an email
  • Send a test copy to yourself (make sure it looks right!)
  • Bcc the email to your mailing list

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Holiday templates

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Postcard templates

Download these free postcard templates to send to your customer data base. Choose any of the options below and personalize it to your satisfaction.

With these postcard templates you have a couple of options:

  • Download and send to your printer as-is and hand write addresses and offers
  • Download with Adobe Reader and type in your addresses and offers, then send to printer
  • Send download and address list and offer to your printer and have them add it in

Click on any of the images below to download a copy of the postcard template.

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Holiday postcard templates

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You can access these free downloads anytime in our Help Center. Happy patient hunting!

Until next time…

Tech Tip: Marketing tips from providers

ClearCorrect Promotional Items

We recently asked our providers for some of their marketing tips and we included some gems that we thought we'd share as well. We hope you find these tips helpful, coming into the holiday season!

  • "People recognize comparisons easily displayed on a vertical poster with pictures." (See our 'Case Types' poster available at store.clearcorrect.com.)
  • "Never sell dentistry. Educate the patient, and let them ask you for it."
  • "Once I get a referral, I have found it easy to convert them to paying patients. First, all of the patients love that I refer them for digital scans. Second, the patients are very impressed by the animation (Treatment setup). Third, I keep a fishbowl full of unused aligners so patients can see and feel them."
  • "We just did a big promo for 25% off that was a huge hit. Completely increased case acceptance and increased knowledge in our community of the service and where it is available."
  • "Asking all patients if they are satisfied with their smile, especially with tooth alignment. Taking photos of all patients."
  • "It's all about initiating conversations. The questions can come from my hygienists, assistants, front office staff, or myself."
  • "Put your whole team in aligners, brackets or retainers."
  • "Offer webinars which would provide education, benefits and potentially a stream of new cases."
  • "We promote ClearCorrect on everything we do: our web page, door hangers, posters in the office--even our business cards. Current upgrades to the ClearCorrect system are prominently mentioned in staff meetings. Our hygienist is on the alert to mention ClearCorrect to likely patient candidates."
  • "After each exam, my hygienist and I ask patients if they know about ClearCorrect. If they don't we explain it to them and show them the clear aligners. We explain to the patients how it works and how they or maybe someone they know could benefit from it."
  • "The main thing we do in our practice to promote ClearCorrect is to charge the same amount for either treatment (i.e. the same cost for aligner therapy or fixed appliances). A lot of times, patients are quoted a higher fee for aligners vs. fixed appliances, so they are more likely to start treatment with us because of our pricing model."
  • "I think it's really just a matter of confidence. If you confidently tell the patient that you have a solution for their smile that doesn't involve 'shots', 'drilling', and is a fraction of the cost of veneers, it's usually a done deal. I am careful not to pressure anyone--it's just presented as an idea. But i can't believe how many people have come back to me at a later time, after not being interested, and have decided to move ahead with treatment."
  • "I had a really nice sign made for my office to advertise ClearCorrect. I forwarded the graphics from your website and had SpeedPro make a sign that shows nicely from the outside of my office, but doesn't show from the inside. From the waiting area you can look right out the window, with no advertising visible. I really like it."

Check out our Help Center for more information on the topic of marketing and practice building. Our online store also has great promotional items for your practice.

Until next time...

Buy the Marketing Kit today!