Tech Tip: Another doctor shares engager tips

Dr. Harvey Mahler of Chicago shared a tip about taking impressions with us last year.

After reading last week's tech tip, he generously wrote in again to share some of his tips for placing engagers:

  • Prior to etching any enamel surface, try the template in to see exactly where the engager will sit.
  • Use air abrasion with 50-micron aluminum oxide to lightly and quickly "prep" the surface. This will clean the surface prior to etching.
  • Then etch for at least 20 seconds (only the area that was air-abraded). Apply resin bonding and light cure.
  • Prior to placing composite in the template, take an explorer or needle diamond and pop a small hole on the engager surface for two reasons:
    • to allow any air to escape and prevent a bubble, and
    • to reduce surface excess for easy clean up.
  • After seating the template and before light curing, wipe any excess that pops through the hole.

Our own engager instructions are available on ClearComm under Documents—feel free to log on and check them out.

Thanks again, Dr. Mahler. Until next time...

Tech Tip: The easy way to install engagers

Thanks for all your responses to last week's tip. We got some great ideas for topics to cover in the upcoming reference guide.

We always love to hear from our providers. Please don't hesitate to let us know if you have questions or tips to share.

Speaking of which, today's tips come to us from Dr. James Grigsby of Garland, Texas. He started treating patients with ClearCorrect as soon as we got FDA approval in 2009, so chances are, he knows what he's talking about.

The easy way to install engagers

Dr. Grigsby calls this "the best tip of all." When he places engagers, instead of using the entire engager template, he trims off the sections that don't have engagers. The engager still gets placed accurately, but it's a lot easier to pry off just a small portion of the template. (We got a similar suggestion from Dr. Mark Bentele last year.)

Dr. Grigsby says that he and his staff "used to sigh" when they had to place engagers because they were so cumbersome, but now it's a breeze.

Slow & steady wins the race

Dr. Grigsby also shared another technique that he says helps him avoid fitting problems and case revisions: all of his patients wear each step of aligners for four weeks at a time instead of three.

He explains upfront to his patients that sticking to his prescribed wear schedule helps to ensure that all of the intended movements have taken place in each step before moving on to the next one.

That technique might not be for everybody, but Dr. Grigsby says he's gotten great results with it.

If you do prescribe a longer wear schedule for your patients, please be sure to let your account rep know, so we can reschedule our production. As we mentioned a couple of weeks ago, if your schedule gets too far out of sync with ours, phases can start to stack up in your office.

Thanks again to Dr. Grigsby. If you have anything you'd like to share, please let us know.

Until next time...

What do you want to know?

Ok, don't tell anybody, but I'm going to let you in on one of the secret projects we're working on. It's a comprehensive online reference for our providers. Think Wikipedia meets ClearCorrect.

It's still very much in progress, but we're letting the cat take a peek out of the bag because we want your input.

What do you want to know more about? Is there something in particular we could explain better? Do you have trouble telling the difference between "phase-based shipping", "Phase Zero", and "Phase Out"? Are retainer requests a mystery?

Reply in the comments of this post and let us know what you'd like help with. The answer might end up as a wiki article, a tech tip, or both!

The great wall of charity

We started the Phase Out program in January of this year. As you probably already know, every time you finish a case, we give $20 for each unused phase to charity: water.

We recently received word that the $36,555 that you helped us raise in the first quarter of 2012 has been allocated to fund our first five projects with charity: water in the Democratic Republic of the Congo. We'll keep you posted as we learn more.

Since the first quarter, we've given $17,250 more. In total, you've helped us raise over $50,000 so far—enough to help about 2,690 people. And we're still going strong.

When we started this project, we started filling up a wall of our lab with little painted green men--one for each person who will gain access to clean water. We put together this little time-lapse video of the first few months… check it out:

How to transfer a case

Sometimes patients move. Sometimes doctors move. Sometimes doctors retire.

One way or the other, if you do enough ClearCorrect cases, someday you'll probably have to transfer a patient before they finish treatment.

Here's how it works: First, you have to figure out who the patient's new doctor is going to be.

Ideally, you'll know a colleague in the area who's already registered as a ClearCorrect provider. Or maybe the patient will find a ClearCorrect provider on their own. If you need help finding someone, you can call your account rep or check the doctor finder on our website.

It's up to you to work out some kind of arrangement with the new doctor. (We do not want to get in the middle of that business.)

case transfer form

Once you've agreed to transfer the case and gotten consent from your patient, you & the new doctor can both sign our handy-dandy new case transfer form. (If it's too much of a hassle to sign a form together, you can submit separate forms.)

Email or fax the case transfer form to your rep, and we'll reassign the case to the new doctor. Phases should start shipping to the new practice after the transfer is complete.

If the doctor you'd like to transfer the case to isn't signed up with us yet, they'll need to contact us to register as a ClearCorrect provider. (If the doctor doesn't have any prior experience with clear aligners, they may need to get some training.)

Once the case is transferred, the new doctor will be responsible for any outstanding costs associated with the case, including any purchases of extra steps or phases.

Please do let us know if your patient is being treated by another doctor, so we can update our records accordingly. We can only accept treatment instructions from the doctor on record, so things can get confusing really fast if some new person we've never heard of starts calling trying to manage a patient's case.

Interview with Dr. Joshua Jones

We went out to New Orleans a few weeks ago to talk to one of our favorite orthodontists, Dr. Joshua Jones. Maybe our best interview yet. Thanks, Dr. Jones!

A few form & policy updates

This week, we're updating a few forms to clarify our policies.

Case submission form

First off, here's our updated case submission form.

Nothing too major here; we're mostly clarifying the instructions and eliminating the extra page listing our terms & conditions. Why waste paper when you can always read the latest terms & conditions online?

Pro tip: Some doctors fill the paper form out chairside and ask an assistant to transcribe it online later.

Case revision form

Next, we have a new case revision form.

If you've been ardently following the revisions to our forms for a while (and honestly, who hasn't?), you might remember that we used to have a single "case revision form". About a year ago, we split it up into two forms to clarify the distinction between midcourse corrections and refinements.

Well, now we've come back to this conclusion: who cares? Midcourse corrections, refinements... same difference. Either way, we're making new aligners based on your instructions and/or impressions. There's still no fee, although you might need to pay a few bucks for a shipping label to send us impressions.

Pro tip: Every case comes with a finite number of phases. Check your treatment plan to see how many phases you have left before you request a change that extends the length of treatment.

Case completion form

Finally, there's a case completion form.

You've always been able to call your account rep to request a free set of retainers after you complete a case.

Now there's a more formal way to do it: the case completion form. Send this in to permanently close your case and request retainers.

If your patient is happily wearing the final step, new impressions shouldn't be necessary, but it might be a good idea to send impressions in if they haven't been wearing their aligners recently.

Pro tip: Don't wait around forever. Your case might be closed due to inactivity if we don't hear from you within 180 days after we ship the final phase (or 30 days after we ship retainers).

Tabby models

You might notice that our latest dental models have sprouted little tabs below the anterior teeth.

Don't worry; they'll still work fine for making replacement aligners and retainers in your office.

We've added the tabs to help us make some improvements to our aligner manufacturing process.

We're not ready to share details about that just yet, but we plan to soon. For now, just enjoy your tabby models and your better-fitting aligners.

Tech Tip: More ClearComm improvements

Our crack team of developers has been hard at work adding features to our case management website, ClearComm.

Here's one new feature: when you submit a case or order a shipping label online, we've added big green, hard-to-miss buttons for printing the label and a case submission record for your files:

The case submission record is for your own files (it even includes the UPS tracking number). When you submit online, you don't have to include a submission form with your impressions anymore, because the shipping label comes with a packing slip instead:

The packing slip includes instructions for completing your submission and all the case info we need to identify your impressions and look up your prescription options. Just cut the page in half, put the packing slip in the box and attach the shipping label to the outside.

"What if I don't print my case submission record? Is all hope lost?" you ask. Well, calm down. (You're so dramatic.) Now you can print case submission records anytime. Just go to your Cases page and click the little PDF icon to print a record for any case submitted online.


Wow, free upgraded shipping and online record storage? This online submission thing ain't half-bad.

Tech Tip: Gaps between aligners & teeth

Intrusions and extrusions are some of the most unpredictable movements to achieve with aligners. Often everything goes as hoped, but other times, those teeth will just stubbornly stay put, causing small gaps between those teeth and the aligner.

Example of gap between tooth and clear aligner

Doctors have several options for dealing with this situation. Here are some of the solutions we've encountered:

  1. Leave it alone. If that particular movement isn't essential to the appearance or function of the teeth, you might just decide it's not worth complicating the treatment to deal with it. (You might need to remove the engager from that tooth if it gets in the way.)
  2. Wait it out. If you have unused phases remaining, you can just stay on schedule until the final step, then target those stubborn teeth by themselves with a refinement.
  3. Bring out the band. Extrusions are particularly difficult for aligners; there's just not much leverage to work with. You can apply some extra force by improvising an auxiliary with some brackets and an elastic band, as shown in this how-to. This is often surprisingly effective.
  4. Let Chewie be your co-pilot. One of the best tools for helping with intrusions are Chewies. Patients love these things. Chewing on those for a few times each day can really help to seat the aligners, relieve pressure, and help to intrude the teeth.