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...  

2015: Year in Review

Happy New Year!

2015 was a fantastic year and we've got an even better year planned for 2016 (our tenth anniversary). In case you missed them, here are a few of the highlights of 2015.

    

  • We went international! ClearCorrect is now available in Canada, Australia, and New Zealand, with more countries coming soon.

    

  • We created our new and improved Help Center, including live chat with support representatives directly from ClearComm.

  • We introduced several new features, including:
    • You're not obligated to pay until you approve a treatment setup
    • You can ask us to recommend a case type
    • We're shipping up to 12 steps at a time
    • You can customize your wear schedule
    • We added a number of new features for retainers, including making multiple sets of retainers available for purchase
    • Discounts are available for case submissions using intraoral scans
    • Volume discounts start at just 5 cases per quarter
    • Limited revisions are a flat rate of $120 plus shipping, instead of $240 per phase
    • We started offering daily, weekly, or instant email notifications, so you can keep up with your cases however works best for your office.

  

Hope your 2016 is off to a great start! Until next time...

Advanced & basic webinars

Webinar

Step up your game with ClearCorrect's new webinars covering advanced and basic topics in clear aligner treatment, presented by orthodontic specialist Ken Fischer, DDS. Each webinar is a PACE approved program offering 2 hours of CE credit upon completion.

To register, call us at (888) 331-3323, or click one of the links below.

Register for Advanced Webinar

Advanced webinar

Available timeslots

  • Friday, 1/8/16, 7–9 pm CST
  • Saturday, 1/9/16, 1–3 CST

Description

From useful troubleshooting techniques to marketing tips, this webinar covers a wide variety of advanced scenarios that can arise in treating patients with clear aligners.

Objectives

  • To improve proficiency in creating the optimum treatment setup
  • Identifying factors involved with monitoring treatment progress with clear aligners
  • Learn techniques needed to keep clear aligner treatment on-track
  • Present advice on how to market ClearCorrect clear aligners

Syllabus

  • Optimizing the Treatment Setup
  • Monitoring Aligner Treatment
  • When Aligners Do Not Fit
  • Finishing Cases
  • Marketing Clear Aligner Treatment
 

Register for Basic Webinar

Basic webinar

Available timeslots

  • Monday, 2/8/16, 2–4 pm CST
  • Tuesday, 2/9/16, 7–9 pm CST

Description

This webinar is ideal for doctors who have had no previous experience with clear aligner treatment. It features demonstrations covering a wide variety of scenarios from real case examples to performing IPR, this webinar has useful information for treating your patients with clear aligners.

Objectives

  • Introduce the concept of clear aligners in orthodontic treatment
  • Introduce the basic concepts involved in the movement of teeth with clear aligners
  • Show the types of treatment possible with clear aligners

Syllabus

  • The Importance of Clear Aligners in Orthodontic Treatment
  • Submitting Cases
  • The Treatment Setup
  • 6 Types of Tooth Movement
  • IPR (Interproximal Reduction)
  • Engagers

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.

  

Happy Thanksgiving

Holiday Giveaway Reminder

In case you missed the announcement last week, we're giving away $100 Amazon gift cards every weekday, plus bigger prizes every Friday. 

This Friday we're giving away a YETI Tundra 75 Cooler...ideal for keeping your family and friends fed and hydrated during a tailgate, BBQ, or day at the beach or lake.

Every treatment setup you approve gives you another chance to win. Good luck!

 YETI_cooler-cropped.jpg

Thanksgiving Sale

We're also offering a 15% discount on all promotional items in our store now through November 30th, 2015. To take advantage of this special offer enter in the following promo code when making your purchase: 15%promo2015

You can visit our store at: store.clearcorrect.com.

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Until next time...

Tech Tip: Setups based on old impressions or scans

When you evaluate a treatment setup, you have four options:

  1. Approve the setup and start the case
  2. Decline the setup and ask for changes
  3. Decline the setup and submit new impressions or scans
  4. Decline the setup and cancel the case

If it's been a while since you took the impressions or scans, you’ll need to evaluate whether they’re still accurate. Only approve a setup if you’re confident it accurately represents the current position of the patient’s teeth. Otherwise, you’re likely to have fitting problems, starting with step 1.

Here's what our Chief Technology Officer, Dr. James Mah, has to say on the subject:

Dr. James MahIt is best practice to promptly revise and approve the setup as the patient's dentition may change over time. The amount of change and the time frame depends on the individual patient. The dentition is not immune to the effects of wear and aging and is more dynamic than most people appreciate.

Practically, patients may be classified in the stable group where any changes are undetectable or subtle enough that there is no effective difference over many months. These dentitions typically have all teeth present in an adult, healthy periodontium, no habits, neuromuscular problems or parafunction and no unusual amounts of dental wear/attrition. A good rule of thumb for these patients is to take new impressions/scans after three months have elapsed to avoid the possibility that changes have occurred.

On the other hand, patients may have unstable dentitions where the teeth may change sufficiently to impair fit of the aligner. A common situation is following extraction of a tooth. Adjacent teeth often shift and the opposing tooth may super-erupt. For this reason, extraction treatments with aligners almost always have the extractions performed only after the aligners are available. In situations involving extractions, there is great variation and in some patients changes over a short period of time such as 2 weeks is enough to cause the aligners to not fit.

Another group that experiences tooth shifting are patients with ongoing periodontal disease. Active periodontal disease is often associated with unintended tooth movement. It is best to manage the periodontal disease and re-evaluate to determine whether orthodontic treatment is even a possibility.

Patients that clench and grind or other situations where there may be loss of tooth structure such as bulimia may also end up with poor fitting aligners depending on the severity of the problem and the amount of resultant enamel and dentin loss.

Unfortunately, in these situations of instability, there are no general rules to follow as each patient is different with different etiologies and severity. Certainly, much is up to the discretion of the doctor but change of some degree is anticipated. For this reason, these treatments have additional complexity and the patient should be informed of the issue. If treatment is elected, the best practice of promptly revising and approving the setup is recommended, rather than allowing the teeth to potentially shift for months before approving.

We hope you found this information helpful.

Until next time...

Tech Tip: Popping TMJ

What should I do if my patient’s TMJ pops when she uses Chewies?

It's possible that the Chewies could be creating a fulcrum point in the patient's occlusal plane, resulting in joint stress and positional changes.

A conservative joint management approach is recommended:

  1. Discontinue Chewies and ask the patient to help seat the trays by pushing up/down with fingers instead.
  2. Ensure the clinical TMJ exam is complete including joint films (CBCT) and a radiologist report. (You need to rule out degenerative joint disease and pathology.)
  3. Continue to clinically monitor the patient's TMJ signs and symptoms at every visit. If pain or limitation of jaw movement is noted, consider pausing treatment and remaining in the previous step until symptoms resolve with conservative therapy (Motrin, no gum chewing, soft diet, limit wide openings, etc.).
  4. Consider a one-year TMJ radiographic examination—if there are no changes from baseline, consider a 3-5 year radiographic follow-up.

Hopefully the patient's joint popping or pain will diminish. If they do, continue on with the patient's aligner treatment. (Steps #2-4 above could also apply to aligner patients who suffer from TMD.)

Don't forget about our Help Center and support representatives—they're chock-full of useful information, and we love hearing from you.

Until next time…

New Advanced Webinar

Webinar

Dr. Ken Fischer presents an informative webinar on advanced topics in clear aligner treatment. From useful troubleshooting techniques to marketing tips, this webinar covers a wide variety of advanced scenarios that can arise in treating patients with clear aligners. The webinar is a PACE approved program offering 2 hours of CE credit upon completion.

Contact one of our sales representatives at (888) 331-3323 to register, or click below to register online.

Date/Time:

Friday, January 8th 2016, 7:00 p.m. - 9:00 p.m. CST.

Saturday, January 9th 2016, 1:00 p.m. - 3:00 p.m. CST.

Location:

Webinar login details will be emailed upon registration.

Webinar Objectives:

  • To improve proficiency in creating the optimum treatment setup
  • Identifying factors involved with monitoring treatment progress with clear aligners
  • Learn techniques needed to keep clear aligner treatment on-track
  • Present advice on how to market ClearCorrect clear aligners

Webinar Syllabus:

  • Optimizing the Treatment Setup
  • Monitoring Aligner Treatment
  • When Aligners Do Not Fit
  • Finishing Cases
  • Marketing Clear Aligner Treatment