Medical device excise tax

As part of the Affordable Care Act, an excise tax is now being levied on certain medical devices. The tax went into effect on January 1, 2013, but we've been deducting the cost of the tax from your lab fees behind the scenes. Unfortunately, to avoid further price increases, it's become clear that we need to start itemizing the cost of the excise tax separately. Within the next few days, you'll see a new line item representing the cost of the 2.3% excise tax when you pay for each case.

We hate passing the tax on to you, but we'd hate raising our lab fees even more.

Until next time…

[Update: We are no longer adding this line item to our invoices. See this announcement for details.]

Tech Tip: Using the ABO Discrepancy Index to evaluate types of malocclusion

Case ParametersBy now, you should be familiar with our case parameters. (They got a slight visual refresh recently, so you might want to download a new copy.)

The case parameters provide guidelines to help you estimate how suitable a case is for clear aligners, and how predictable you can expect the movements to be.

For instance, a few millimeters of crowding can usually be corrected easily and quickly with clear aligners, while a case requiring lots of extrusions is likely to be much more difficult.

But how do you know exactly how much crowding there is? What do you measure to determine the amount of overjet?

This is probably basic stuff for many of you, but if you need a refresher, you may want to have a look at the American Board of Orthodontics' Discrepancy Index.

The ABO originally developed the Discrepancy Index in 1998, and its been refined in the years since. It provides standardized methods for measuring types of malocclusion, and also offers a simple point scale for determining the severity of a case. They've produced a PDF guide and a series of YouTube videos demonstrating how to measure and identify common types of malocclusion.

We don't currently use the ABO Discrepancy Index ourselves, but we thought some of you might find this a useful resource regardless.

Tech Tip: Orthodontics and ibuprofen don't mix

Tooth & gum pain is a common side effect of most orthodontic treatments, and clear aligners are no exception. The discomfort can be particularly intense when a patient first puts on a brand-new aligner.

Over-the-counter pain medications can help, but did you know that some pain relievers can inhibit the successful movement of teeth? In a 1996 study, researchers placed orthodontic appliances on guinea pigs and tested the effects of ibuprofen (Advil), acetaminophen (Tylenol), and misoprostol. They found that ibuprofen significantly inhibited the movement of the teeth. They did not specifically test the effects of aspirin or naproxen, but those belong to the same family of NSAIDs, so it's probably safest to avoid those as well.

Fortunately, acetaminophen had no effect on the movement of the teeth compared to the control group.

So, ClearCorrect patients: reach for the Tylenol, and leave the Advil on the shelf.

Until next time...

Source: Michael J. Kehoe, Steven M. Cohen, Kourosh Zarrinnia, and Alan Cowan (1996) The effect of acetaminophen, ibuprofen, and misoprostol on prostaglandin E2 synthesis and the degree and rate of orthodontic tooth movement. The Angle Orthodontist: October 1996, Vol. 66, No. 5, pp. 339-350.

Tech Tip: Request retainers & view expiration dates on ClearComm

A couple of weeks ago, we reminded you that cases are automatically closed when you request a free final retainer, or one year after your last shipment, whichever comes first.

Starting today, you can add retainer requests to the list of new features available on ClearComm, along with case histories, intraoral scans, revisions, invoices, and treatment plans.

After the final phase has been delivered, you'll see "Request final retainer" at the top of the case page. You'll also see the expiration date for the case.

Request final retainer

From here, you can request a revision or close the case by requesting the final retainer. We can make retainers based on the last step, or you can submit new impressions or intraoral scans.

Closing case

If the retainer is based on an existing step, just click "Submit" and you're done. If you choose to send in impressions or scans, you'll be presented with options to upload or ship them after you submit your request. You can find cases that are ready for you to request a retainer under the in progress section of your case list.

In progress

Let us know what you think of the new features, and anything else you'd like to see. Until next time…

We’re moving to Round Rock!

You don't have to update your address book just yet, but we're so excited, we wanted to share the news a little early. After an extensive search, we've finalized plans to relocate our headquarters and manufacturing operations from Houston to a new improved facility in Round Rock, Texas (just north of Austin).

ClearCorrect key

If all goes according to plan, we expect to start the move in August, and finish up over Labor Day weekend. We'll update you with more details as the big day draws closer. We couldn't be happier with this move. Houston's been a great home for us so far, but the fun, high-tech Austin scene aligns even better with our core values, and we think it'll be the ideal environment for us to continue our long-term growth and prepare for international expansion.

Of course, we wouldn't be here without our providers, their patients, and everyone who we've worked with over the past six years. Thank you for all your support. It's been quite a ride, and we look forward to many more years of service in our new Round Rock facility. Until next time…

Tech Tip: Invoices & treatment plans available on ClearComm

Our technical team has been busy—the new ClearComm features just keep on coming. After introducing a new case history view, intraoral scans, and online revisions, today we're announcing that you can view invoices and case paperwork directly on ClearComm.

After we added payments to the case history view, some providers told us that they'd rather not see the specific lab fees there. In response, we've updated the description to just read "Payment received."

Payment received

Instead, you can now click the invoice icon to view a printable PDF with the full details of each transaction.

We've also added downloadable treatment plans for recent phases. (This is the same paperwork that comes in each aligner box.)

Phase 1 arrived

Same idea: just click the icon to download a PDF. Because this is a new feature, it's only available for phases that shipped in the last couple weeks. Over time, you'll start to see it on more and more phases. Don't forget that you can check the timeline at the top of each treatment plan to get a preview of what's coming up at future appointments.

Request revisions online

As promised, we've been adding new features to ClearComm on a regular basis. Last month, we introduced the new case history view. A few weeks ago, we started accepting intraoral scans. And today, we're pleased to announce that online case revisions are now available.

Phase 4 of 5 scheduled

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

Requesting revision

For each arch, you'll select the step that your patient is currently wearing. (Your patient should continue to wear the same step until the revised phase arrives, then switch directly to step A of the new phase.)

We can base the revision on existing models, on new impressions, or on new intraoral scans. If the aligners fit well, but you just want to request a change (for instance, adding engagers or requesting overcorrection), select "existing model." If you choose "new impression," you'll be presented with an option to ship it after you submit the revision request. If you choose "new intraoral scan," you can upload it along with the revision request, or submit the request first and upload the scans later.

Whichever option you choose, you'll need to provide some instructions explaining why you want a revision, and what you'd like us to change. Then just hit submit, and you're good to go. You don't need to send in a paper form, but if you want one for your records, you can download one by clicking the revision form icon in the case history.

Revision received

If you have any questions or feedback about this process, please let us know. Until next time…

Check laser–marked aligner codes to avoid mixups

For aligners to do their job as intended, it's important to wear them in order. Unfortunately, because aligners look so similar, it's not always easy to tell when they've been shuffled out of sequence. This can happen at the office, in the patient's possesion, or (though we do our best to prevent it) it's occasionally possible for them to be mixed up during packaging.

That's why last summer, we started laser–marking aligners. Of course, your first reference is going to be the step number printed on the aligner bag, but the laser markings provide a way to double–check that you're dispensing the correct aligners to your patient. Your patient can use them, too, to keep track for themselves. Here's what you'll be looking for:

The first section of the code represents the patient's ClearCorrect case number. This number is referenced on ClearComm, on the treatment plan, and in most emails from ClearCorrect.

The next section represents the step number. The example above shows a Phase Zero aligner. Usually, this will be in the form of a letter and number. For instance, step 4A (representing the first step of Phase 4) would be followed by 4B, 4C, 4D, and then 5A.

And the final section represents whether the aligner is for the upper (U) or lower (L) arch.

You'll also find matching codes on the bottom of each dental model.

Occasionally you may receive an unmarked aligner (for instance, engager templates are currently unmarked). In that situation, you can double–check aligners by comparing them to the dental models. We have some upgrades planned which should enable us to laser–mark 100% of aligners and engager templates soon.

If your patient does end up wearing aligners out of sequence, don't panic. It's usually not an insurmountable problem. Assuming that the aligners fit well and there aren't any complications, you can identify which step best corresponds to the current position of the patient's teeth and continue from there.

If you have any suggestions for how we can make things easier for you, please don't hesitate to let us know. Until next time…

Tech Tip: Preventing pop-ups with Hilliard thermopliers

We talked earlier this year about using Hilliard thermopliers to finish out a case and complete a difficult movement. Today, we'd like to share another great use for thermopliers.

Sometimes, aligners just don't want to stay down, especially in the posterior. This is often caused by a lack of adequate retention points. Aligners work best with bulbous teeth. Some teeth are just so short or straight-edged that the aligners don't have anything to grab onto.

Fortunately, there's an easy fix that doesn't require remaking the aligner or requesting a revision to add engagers. Simply heat up the pliers and make a dimple between two teeth on the facial and lingual sides of the aligner. You'll want to place the dimples down by the gumline, so they can tuck in between the bases of the teeth.

It's a quick and simple trick, but it can make a world of difference.

ClearCorrect now accepts intraoral scans

Now you can choose whether to submit your cases with traditional PVS impressions or go all-digital with intraoral scans. We've been testing this feature with our PREP group for a while, and now we're ready to open it up to the public.

Naturally, we won't restrict you to any particular brand or model—we'll accept scans from any intraoral scanner, as long as they're in STL format. (STL is an open, industry-standard file format that can be exported by most popular scanners.)

We've already tested scans from a wide range of scanners, including the 3M™ True Definition Scanner, 3Shape's TRIOS®, and even Align Technology's iTero™. Please do your research before you buy a new scanner, though. Confirm whether you'll be able to export STL files with your reseller or manufacturer. Some models may require a service or software upgrade to enable STL export functionality.

You'll download your STL files from your scanner to your computer, and upload them just like your photos when you submit a case online. When you do, we can start working on your case immediately instead of waiting for your impressions to arrive. We expect all-digital cases to get turned around days faster, with more accuracy.

If you don't have a scanner yet, don't worry. You can just keep doing what you're doing. We're happy to accept impressions as well.

Exporting tips

We strongly recommend that you visually inspect your STL files before you submit them to us. Our favorite STL viewing application is netfabb Studio Basic, which is available free for Windows, Mac, and Linux. Other options include MiniMagics and FreeCAD.

Some scanners output several files, but the only ones we need are the upper and lower arches. The arches should be saved in separate files, with the arches oriented in occlusion.

We prefer "closed shell" models, but "open shell" models are acceptable too.

When you scan a patient with an iTero scanner, choose the iCast or iRecord format. The Invisalign format will not permit you to export STL files.

We can't provide support for your scanner software, but if you've got any other questions, as always, your account rep is here to help.