Tech Tip: How to submit cases with a CEREC scanner

  1. Open the CEREC Connect application on your scanner. (You can download CEREC Connect here if it's not already installed.) Make sure you're using CEREC Connect, not the regular CEREC software for in-office milling!
  2. Click "Add New Patient". Enter your patient's full name and date of birth, along with the treating doctor's name. You can leave the patient's ID number blank.
  3. Click "Add New Case". Unfortunately, the CEREC system wasn't designed with clear aligners in mind, so you'll have to make a few random selections just to get through the Administration phase. You can select any tooth, any indication, any type, any material, and any shade. We won't use any of this information—you just have to select something to get through the process. It's not elegant, but it works for now. Once you get through this process for one tooth, click the double arrows (>>) at the bottom of the screen to advance to the Acquisition phase.
  4. Scan the teeth. Make sure you capture at least 2-3 mm of clear gingival area, without distortion or gaps. The cleaner and more accurate you can make the scan, the better the aligners will turn out. Once you've got nice scans of both arches and a buccal bite, click >> to advance to the Model phase. The scanner will probably spend a couple of minutes generating virtual models.
  5. Articulate the models. Feel free to get rid of any unwanted artifacts, but other than that, don't worry about trimming or drawing margins—all we need are properly-articulated models of the teeth. Once you finish the buccal bite registration, click >> to advance to the Connect phase.
  6. Log in to the Connect Portal. If this is your first time logging in, click Register to open sirona-connect.com in a new browser window. After you register, you'll receive an email from Sirona with a link you need to click to verify your account. Once your account is all set up, return to CEREC Connect to log in with your username and password and click OK. As soon as you log in, your order should start uploading in the background.
  7. Set ClearCorrect as your laboratory. Click "Enter Order Data". If you don't see ClearCorrect listed as one of your favorite labs, click "Edit Your Favorite Laboratories". (You might have already set this up during registration.) The laboratory selection page will open in a browser window. In the Company Name field, type in "ClearCorrect" (remember, there's no space in our name) and click Find. We'll be listed under the map. Check the box next to ClearCorrect and click "Add", then return to CEREC Connect and select our lab icon there. You'll be asked to choose a return date—this has no effect on your case, so choose any date you like.
  8. Add additional information. On the next page, you'll be asked to select the gender of the patient and add any notes. Don't rely on this section to tell us important information about the case—you'll add your actual instructions on ClearComm. If you like, you can use this area to enter the treating doctor's name (and a case number, if you already have one).
  9. Submit the intraoral scans to ClearCorrect. Click "Add to Cart," then "Submit Cart." You'll be asked to verify your username & password, then click OK.
  10. Submit your case on ClearComm. This is important—sending us scans through CEREC Connect is just one step in the process. You'll also need to submit a new case through ClearComm. (Otherwise, we won't have a prescription, a case type, photos, or a lab fee!) When you get to "Impressions or scans," select "CEREC scan." It'll work best if you submit both the case and the scans on the same day.

Please feel free to share your tips and feedback with us, and check with your distributor or ask Sirona if you need help with your scanner.

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.