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.

ClearCorrect Editorial: The Benefits of Clear Aligners

The New Dentist Journal recently wrote an article about the benefits of using clear aligner therapy. 

Read the article here…

ClearCorrect advanced training series

We're happy to announce a new series of advanced webinars. Every month, we’ll cover a different topic related to clear aligner treatment.

Each webinar is 1 1/2 hours (including a Q&A period) offering 1.5 hours of CE for attendance to each.You can purchase individual webinars for $95.00.

Special training series packages

We are also offering a discounted package price (until the end of March) for all 9 webinars at a total of $500. Attendance to each webinar will add up to 13 CE credits.

For new providers: For any new providers who purchase the package, we are offering it along with a Basic Webinar for a total price of $595.00. Attendance to each webinar, including the Basic Webinar, will be a total of 15 CE credits.

Advanced training series schedule

Interproximal Reduction (IPR)

  • Tuesday, March 29th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Wednesday, March 30th, 2016: 7:00 p.m - 8:30 p.m. CST

Webinar Objectives:

  • To instill confidence in performing IPR
  • Identifying common problems in performing IPR
  • Learn useful troubleshooting techniques
  • To offer successful tools & tips for performing IPR

Engagers (Attachments)

  • Tuesday, April 5th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Wednesday, April 6th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • To instill confidence in installing and removing Engagers
  • Learn how to become proficient in seating and removing engager templates
  • To learn troubleshooting techniques
  • To offer successful tools & techniques for installing Engagers

Case Submission, Prescription & Treatment Setups

  • Tuesday, May 24th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Wednesday, May 25th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • Identifying how to decide which cases are good for treatment with clear aligners
  • Understanding how to submit an informative and effective case prescription
  • Learn how to anticipate problems pre Treatment Setup
  • To improve proficiency in creating the optimum Treatment Setup

Impressions

  • Monday, June 27th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Tuesday, June 28th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • To become proficient in taking impressions without problems
  • Learn techniques for troubleshooting impressions
  • Understanding undercuts and how to deal with undesirable undercuts
  • To offer successful tips & tricks for taking impressions

Managing Treatment Progress: Checkups & Revisions

  • Friday, July 8th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Saturday, July 9th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • Learn how to manage non-compliant patients
  • Improve understanding of revisions and how to use them to obtain your treatment goals
  • Learn what to do with aligners that don't fit
  • Learn techniques needed to keep clear aligner treatment on-track

Auxiliaries

  • Monday, August 29th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Tuesday, August 30th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • Learn techniques for extruding and rotating with auxiliaries
  • Learn how to use pontics in clear aligner treatment
  • Identifying when and how to use dimples in clear aligner treatment
  • To become proficient in using additional auxiliaries such as expanders, elastics, limited braces, etc.

Managing Difficult Movements: Troubleshooting

  • Tuesday, September 13th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Wednesday, September 14th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • To improve proficiency in using various troubleshooting techniques available for clear aligner treatment including; severe rotations, small teeth, intrusions, extrusions, and more

Retainers & Finishing Cases

  • Friday, October 14th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Saturday, October 15th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • Know when it's time to order retainers and what type of retainer is best for your patient
  • Learn how to fine tune and finish treatment
  • Understanding issues that can arise at the end of treatment such as; incomplete corrections, how to idealize occlusion, residual spacing, open bite and more

Marketing

  • Monday, December 12th, 2016: 2:00 p.m. - 3:30 p.m. CST
  • Tuesday, December 13th, 2016: 7:00 p.m. - 8:30 p.m. CST

Webinar Objectives:

  • Present advice on how to market ClearCorrect clear aligners
  • To offer successful marketing tools for promoting ClearCorrect & your practice

Go to store.clearcorrect.com to make your purchase today!

We hope you take advantage of this great deal!

ClearCorrect is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 4/1/2015 to 3/31/2019. Provider ID 304173.

Texas CEO Magazine Interviews ClearCorrect's CEO Jarrett Pumphrey

Texas CEO Magazine recently sat down with our very own CEO Jarrett Pumphrey who shares his vision on staying flexible in an ever changing world.

 “We are pretty agile. That’s not something you’ll find in a lot of medical device companies,” Pumphrey says. “We found a way to strike a balance between maintaining that flexibility and making a quality product that conforms to the rules and regulations we have to meet.”

Check out the interview here: http://www.texasceomagazine.com/features/a-vision-clear-and-straight/ 

  

Tech tip: Undesirable undercuts

Desirable vs. undesirable undercuts

Mosby's Dental Dictionary defines an undercut as "the portion of a tooth that lies between its height of contour and the gingiva, only if that portion is of less circumference than the height of contour." Aligners rely on these naturally-occuring desirable undercuts for normal retention.

Undesirable undercuts, however, are too retentive, making it difficult to remove impressions or aligners. Some common causes of undesirable undercuts include:

  • Gingival recession creating a notch at the cementoenamel junction
  • Under-restored dental implants and bridges
  • Anomalous tooth morphology
  • Overcontoured restorations

How to deal with undesirable undercuts

One of the most common techniques for dealing with undesirable undercuts is to block them out:

  • Before taking impressions, fill in the undesirable undercuts with a soft material that will not bond to the impression (like wax). This will make the impression easier to remove, and also eliminate those undercuts from the resulting 3D model, making the aligners easier to remove as well.

Another technique is to trim the medium body material:

  • Between the first and second steps of a two-step impression, use a knife to trim away the impression 2 millimeters above the gingival in the medium body material. This will ensure that the only material covering the undercuts is the flexible light body material, allowing the impression to be removed easily.

Note that if you use this technique (or if you take intraoral scans), the undesirable undercuts are still likely to show up in the 3D model and aligners. In these situations, you may want to ask ClearCorrect to block them out digitally:

  • When you submit the case, use the additional instructions section to describe any undercuts that you want ClearCorrect's technicians to digitally fill in. When you get the treatment setup, inspect these areas of the 3D model carefully to ensure that they meet your expectations.

We hope this information was helpful to you!

Until next time...

Tech tip: Fitting & tracking issues

How can I tell whether an aligner fits?

A properly fitting aligner should cover the teeth and fit snugly against the patient’s teeth. It will probably feel a little tight at first.

  • The aligner should usually cover the gingival by at least 0–2 millimeters. (Aligners may be trimmed differently to compensate for undercuts, black triangles, recession, bridges, etc.)
  • The incisal edges of the teeth should fit flush against the aligner without any gaps.
  • The aligner should fit snugly over the distal surfaces of the rearmost molars, if the aligner extends that far back.


Properly fitting aligners

Fitting issues

There are a few possible causes for fitting problems:

  • If the first step doesn't fit, the most likely cause is an inaccurate 3D model. This can be caused by distortions in the initial impressions or scans.
  • If the fit of the aligners gets worse over time, the teeth may not be "tracking"—in other words, the aligners are progressing as originally planned in the treatment setup, but the actual teeth aren't keeping up due to lack of space or insufficient pressure.
  • In rare circumstances, an aligner may be distorted due to physical damage or a manufacturing defect.

Some common types of fitting issues are shown below. Click a photo for detailed troubleshooting information.

Incisal gaps 


Aligners that are too big or too small


Aligners that fit on only one side

Tracking issues

Even if the aligners do appear to fit comfortably, that doesn't guarantee that the teeth are actually moving as intended. Here are some tips for identifying unseen tracking issues before the treatment goes too far off the rails:

  • Any patient non-compliance can lead to tracking issues. Educate your patient on the importance of wearing their aligners at least 22 hours per day. Signs of non-compliance include missed appointments, unusually clean aligners, and a persistent tight fit after weeks of wear. Make sure your patients know they should contact you immediately if their aligners no longer fit.
  • Saliva buildup or saliva bubbles inside the aligner often indicates that there is a significant gap between the aligner and the teeth. This will most likely be seen at the trim line.
  • Blanching of tissues indicates soft tissue impingement. This could be the result of inaccurate capture of these areas in the impression or the result of a frenum that extends towards the gingival margins.
  • If the aligners are slightly ill-fitting when you give them to your patient, but the patient calls back a few days later saying that they now fit, don't rely on that self-assessment. Do a follow-up visit to confirm the quality of the fit before advancing to the next step.
  • Even if the aligners are fitting during check-up appointments, you should check the treatment setup and paperwork to see which teeth are moving and if those teeth appear to be on course. If you see that a tooth is not moving as planned, don't wait, take immediate action. If you continue with treatment in hopes that it will correct itself later on, it may get worse.

We hope you found this information helpful!

Looking for something?

We have a great online store filled with useful tools to help you in treating your patients with clear aligners. Everything from IPR Kits and Chewies to Webinars. Check out our store at store.clearcorrect.com.

Until next time…

Tech Tip: Video - How to Take Photos & X-rays

We've created a video giving some helpful tips on how to take good photos of patients' teeth before submitting a case to ClearCorrect. Check it out!

We hope you found this video helpful! Feel free to check out our Help Center which is filled with useful tips, tricks and information to help you in treating your patients with ClearCorrect.

Until next time...

Tech Tip: Support Tips

We know that occasionally you can run into issues during treatment (aligner errors, a rotation not occurring as planned, fitting issues, occlusal gaps, etc.)

Our support representatives are here to assist you with any trouble you run into. We thought we would offer up some tips to assist you in getting your issue resolved as quickly and efficiently as possible.

Take a picture

We believe that sometimes a picture is worth a thousand words. Taking a picture of the problem you're having and sending it to one of our experienced support representatives can speed up the process and makes a huge difference in being able to resolve issues with certainty.

We'll need a close up clear picture of the occlusal, right and left lateral views of the arch in question both with and without the aligners.

So, if you can, take a picture of the problem you're having and send it to support@clearcorrect.com.

Give support all the information

When getting assistance from a support rep, they need to know as much information about the issue you're having as possible in order to better assist you. When you send in a support request be sure to give the following information:

  • Verify the step and case # marked on the aligner that the patient is trying on.
  • Confirming when and what step the issue started.
  • Was there any troubleshooting already done to correct the issue?
  • If yes, what troubleshooting techniques did you already try?
  • Is the patient compliant?

Fitting issues

Before you call support about any fitting issues, you may want to review the options you have available to you first:

  • Checking and breaking tight contacts in the area where the fitting issue is present.
  • If there are difficult movements present in the area with the fitting issue you can try backtracking with a fresh aligner, dimples, auxillaries, and chewies to get it back on track.
  • Reiterating patient compliance.

We hope you found this information useful!

Until next time...