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.

We've talked before about how important it is to express your intentions clearly when you request a case revision. (See this previous tech tip for details.) Taking a few moments to double-check your revision form can save a lot of wasted time down the line.

Here's one issue that's tripped up a few doctors: they check the box requesting overcorrection of a tooth, but then provide conflicting instructions elsewhere on the form.

When you request overcorrection, this indicates to our technicians that you'd like to continue moving teeth in the same direction as originally planned -- just with a little extra pressure. If we got a form with conflicting instructions like this one, we'll have to guess which instruction to follow, and we won't always guess right.

If you don't want overcorrection, don't check a box in the tooth chart. Just list the teeth by number in your written instructions.

The appointment when your patient receives Phase Zero and views the treatment setup is often the most anticipated appointment. This is your patient's first experience with aligners, and they are usually anxious to start treatment and see results. If you help your patient view Phase Zero as an opportunity to get used to treatment, they will be mroe compliant with your instructions and confident in their progress.

This week, we're providing answers to questions that your patients might ask about Phase Zero.

What does Phase Zero do?

Phase Zero is a set of passive aligners that helps you get used to treatment while your active aligners are being planned and manufactured. During this time, you'll get used to cleaning your aligners, get lots of practive applying and removing them, and start to adjust to any "lisp" or foreign feeling they cause. After wearing Phase Zero, you should be comfortable wearing aligners.

Will Phase Zero move my teeth?

No. Phase Zero aligners aren't designed to move the teeth. They're passive -- just like a retainer. They help your teeth stay in the position they were in when your doctor took your impressions, so that your first active set of aligners will fit and you can start treatment right away.

Phase Zero is really uncomfortable. Is there something wrong?

It's not unusual to feel a little bit of pressure or discomfort when snapping in the Phase Zero aligners for the first time -- especially if you're never had orthodontic treatment. However, this doesn't necessarily mean that there's a problem. As long as the aligner fully seats over your teeth, you're good to go.

To help ease the discomfort and pressure of a new aligner, try soaking them in warm water or biting down on some Chewies.

What happens next?

If Phase Zero fits well, your doctor can approve the treatment setup, and ClearCorrect can start planning & manufacturing phase 1. If Phase Zero doesn't fit, your doctor will probably want to take new impressions and send them in.

Have you run into any other questions during Phase Zero fitting appointments? Let us know how you answer them in the comments.

In light of our recent tech tip, Dr. Rick Gennaro sent in a great tip from an experience reviewing problematic impressions in a friend's lab:

I was shocked to see how poor the majority of impressions were. Improper tray selection, re-seating the tray, combining unrelated materials (i.e. PVS with polyether), inconsistent mixing, air entrapment, etc., all contribute to the problem.

A lot of what I saw, aside from inadequate preps and poor tissue control, was a simple issue of not having cleaned off the teeth and tissues, leaving behind debris and fluid. Unclear details and air bubbles were prevalent, and this was from several dentists. Cleaning with peroxide and washing would have helped greatly.

Cleaning the teeth and gum tissue before impressing to remove plaque, fluid, and other buildup creates a clean slate for the PVS material. Also, if you've already taken multiple impressions on the same patient in one sitting, be sure to clean the teeth before re-impressing each time. This improves detail and prevents air entrapment. 

Air entrapment can also occur when dispensing the material, if you're not careful.  If you lift the tip of the gun while dispensing, it can create pockets of air within the material that distort the accuracy of the impression. To prevent air entrapment, keep the tip of the gun down and dispense the material evenly, as Dr. Pumphrey demonstrates in this video.

Thanks for the tip, Dr. Gennaro! How do you achieve the best results with your impressions? Share your own experience in the comments section below.

A high-quality impression is the foundation of a successful case. Whether for a submission or a revision, accurate impressions are vital to ensuring that treatment is effective and time-wasting delays are avoided. 

We've listed our guidelines for a good impression below. Follow along and view an example of an excellent impression on our printable guide:

Detailed, accurate occlusal surfaces.

A clear impression of the occlusal surfaces ensures that the aligners will have a tight fit.

• Sharp cusps

• Tray doesn't show through impression

All gingival margins are defined and clear.

Defined gingival margins ensure enough retention points are present for effective tooth movements.

• Includes about 2mm of buccal and lingual surfaces outside gingival margin

Distal surfaces of molars are captured.

This is a common cause of missing retention points and fitting issues during phase 0. If your patient has short clinical crowns, getting a clear impression of the molars is especially important.

• More than half of each molar is visible

Impression material is intact.

Damaged or thin impression material compromise the accuracy of the molds and resulting aligners.

• No damage, warping, or separation of light and heavy material

No imperfections in the impression material that compromise dental anatomy.

Imperfections or double imprints in the impressions could affect the effectiveness of treatment with the resulting aligners.

• No bubbles, voids, thin walls, shifts, or double imprints

More Helpful Tips:

• Make sure the tray is not too small and fits your patient well. If the teeth are touching the edges of the tray, the tray is too small.
• Use plenty of PVS material. It's better to have too much than too little.
• Remove all engagers prior to taking the impression. We need impressions free of attachments to make accuracte molds.
• Fill in black triangles with wax. This will allow you to remove the material cleanly without creating pulls or distortions.
• Refrain from moving the material as it sets. We recommend waiting an additional 60-90 seconds longer than instructed before removing the trays from the patient's mouth.
• Don't forget the light body material! Add the light body before the putty or heavy body dries completely.

I have a teenage patient who plays contact sports. Can she wear a mouthguard during clear aligner treatment?

Protecting the teeth and face against injury with a mouthguard while playing contact sports is extremely important, especially when your patient has invested time and money into their orthodontic treatment.

The patient may simply remove their aligners and wear a standard mouthguard during sports practice or games, then replace the aligners right after the activity is over. Instructing the patient to keep their aligner case in their sports bag (with Chewies to help seat the aligners) will also encourage compliance. 

If you or the patient are concerned about removing the aligners for an extended period of time, you may instruct the patient to wear a mouthguard with their aligners. Companies like Shock Doctor make special mouthguards for patients with orthodontic treatment. Be sure to use an aligner that doesn't need to be worn anymore (or make a "sacrificial" aligner in your practice) when fitting the mouthguard to protect the integrity of the patient's current step.

Remember -- ClearCorrect aligners should never be used in lieu of a sports mouthguard, and the patient's teeth may move slightly during any time they are not wearing their aligners. Please use your best judgment when instructing your patients on treatment.  

We are constantly inspired by our providers' dedicated approach to their patient's treatment. This week, Dr. Gene Shapiro shares two valuable tips on how to properly seat and easily remove the engager template without disrupting the engager.

Seating the engager template

Sometimes, the engager template can be difficult to seat, which may lead to inaccurate placement of the engagers.

Here's how Dr. Shapiro seats his engager templates:

I simply deliver the engager template to the patient as a next set of trays 1-2 days before the engager placement appointment, and ask them to wear [the templates] instead of the current [aligners].  I also make sure they wear them in the same manner as they would the aligners.

By the time they return to have the engagers placed, the trays are now seated perfectly and exact engager positioning is achieved every time.

Removing the engager template

Removing the engager template after placing engagers may also prove difficult. When the engager is bonded correctly, the engager template will be formed tightly around the teeth, making it difficult to pry off without disrupting the bond or scratching the engager.

Dr. Shapiro shares his trick for removing engager templates by splitting them mesiodistally:

Using a medium grit diamond bur, I thin out a few spots along the central fossae of the molars.

Then, using curved Goldman-Fox scissors, I create small "snaps" or cuts all along occlusal in mesio-distal directions.

I gently lift the areas around the borders of the cuts with a curette.

By now, the templates are easy to cut along the occlusal surfaces. This allows me to separate the buccal and lingual parts of the templates.

Thanks for sharing, Dr. Shapiro! Do you have your own methods for placing engagers or dealing with engager templates? Let us know in the comments!

Today's tip comes from Dr. Clayton Floriani, who shares two methods to successfully finishing out a case with difficult movements without submitting a revision:

I bought a set of thermopliers to place a bubble in the aligner to give it an extra push. This helps, and usually keeps me from having to take a new impression.

You can find a wide range of Hilliard thermoforming pliers, and instructions on how to use them, on the Dentsply website.

Pictures courtesy of Bay Materials.

Dr. Floriani shares a second tip for preventing a refinement:

I have found that some final movements can be impeded due to the aligner plastic being too tight/thick in the embrasure space. I just thin the plastic out using a diamond bur in my high speed handpiece.

For example, if I am pushing the tooth facially, I'll thin the plastic out on the lingual embrasure so that the tooth has more room to move. This helps me get the contacts lined up.

Thanks Dr. Floriani! If you have any tips you'd like to share, please let us know in the comments. 

This week, we've answered some frequently-asked questions about our aligner material. Got more questions? Feel free to ask them in the comments section below.

For further reading and complete information about our aligner material and safety information, view and download our material information on ClearComm. 

What are ClearCorrect aligners made out of?

Our aligners are made from Zendura, a custom formulation of medical-grade polyurethane which has been thoroughly tested for biocompatability. This advanced plastic was created exclusively for ClearCorrect by Bay Materials.

Are ClearCorrect aligners BPA free?

Yes! Our aligners are FDA approved and free of bisphenol-A ("BPA") and phthalates. 

Are ClearCorrect aligners safe for patients who are pregnant or nursing?

As stated in our material information, our aligners are free from harmful chemicals and do not pose a significant risk to the patient's health. However, as the doctor, we leave the treatment decisions up to you. We are committed to providing all the information available on our aligner plastic so that you and your patient can make an informed decision together.

Can my patient drink hot beverages like coffee or tea while wearing aligners?

We don't recommend it. Hot liquids can distort the material. Coffee and tea are also likely to stain the aligners, and sugar can get trapped between the teeth and the aligners. It's best to remove the aligners before eating or drinking anything other than water.

Is the Zendura used to make the aligners the same as the Zendura sold in the online store?

Yes! The same Zendura plastic used to make your patients' aligners is available on our online store at a providers-only price of $60 for 20 sheets. This way, you won't have to compromise quality for the convenience of making your own aligners in-house.

What machines can I use to make my own Zendura aligner?

Bay Materials recommends the use of a pressure-forming machine (such as a Biostar, MiniStar, or Drufomat) when thermoforming Zendura plastic. However, you may achieve great results using a vacuum-forming machine by following these specific instructions.

Bonus question:

What kind of material are your models made from?

The models included with each aligner shipment are made from VeroDent, a biocompatible photopolymer engineered by Objet specifically for dental applications. You may view a video of our 3D printers in action here (video produced by Objet).

This week we want to share another case study of a difficult ClearCorrect case that finished successfully without a revision because the doctor was hands-on with treatment. 

Here's a scenario from a real-life case:

A provider submits an Unlimited case for a patient with heavy crowding and rotated upper lateral incisors in need of extrusion. The patient was compliant, the provider performed the recommended amounts of IPR, and treatment progressed smoothly. However, the lateral incisors stopped tracking once the patient got to phase 5. The incisors were scheduled to rotate, but contacts with other teeth got in the way. 

Constant, steady pressure and adequate space are needed to complete any tooth movement. Because the engager wasn't tracking and heavy contacts blocked the movement, treatment could not progress as planned. Instead of sending in a case revision, this provider placed auxiliary brackets on the lingual surface of the incisors to complete the difficult extrusion.

If you are in a similar situation, follow this provider's steps to solve the problem: 

• Follow our guide to placing auxiliaries on the affected teeth, including removing and replacing the engagers. (Previous tech tips give many guides to making new engager templates and troubleshooting engagers that aren't tracking.)
• Break tight contacts on the mesial and distal sides of each affected tooth to ensure that the tooth has enough space to move.
• Give your patient a bag of 1/4" elastics after the procedure, just like a traditional wire-and-bracket case. Because elastic bands lose their retention after about an hour in the mouth, instruct the patient to replace them frequently -- after eating, drinking, or brushing.
• The patient's compliance and dedication to treatment is an integral component of sthe success of this procedure. Ensure that your patient wears their aligners for 22 hours a day, and regularly replaces their elastics.
• If you need more time to backtrack treatment before moving to the next step, call or email your account rep to place the case on hold. By holding the case until you're ready for the next step, you can stay in sync with our timeline and avoid wasting shipments. 

With the addition of auxiliaries, the aligners had enough constant, steady pressure to finish the movement as predicted on the treatment setup. With that movement out of the way, the case progressed smoothly into completion with fantastic results.