Sirona announces CEREC® ortho software

Going digital has never looked better

ClearCorrect is proud to annouce that it's working with Sirona, a giant in the dental industry, to develop a new generation of software that allows dentists to use their CEREC® scanner for orthodontic applications.

Sirona has over 50 years of experience in orthodontics, and was the first to introduce digital imaging to dental practices everywhere with the OPG and CEPH X-Ray units.

What this means for you: you'll be able to quickly capture a full 3D image of your patient's dentition with Sirona's patent pending guided scanning process, review the images with the patient and diagnose their needs with a seamless 3D interface, and deliver all this information to us directly so we can get started on manufacturing your patient's aligners.

Check out the full press release here.

The new treatment setup is here!

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Good news, everyone!

We've finished beta-testing the new treatment setup, and we're starting to roll it out to all of our doctors. It's going to be a gradual transition, so don't be surprised if you receive the older style of setup during the next few weeks.

If you want to play around with the setup early, you can download this sample.

We've prepared a brief video demonstrating some of the new features, including:

  • Color gums & teeth
  • Models for every step of treatment
  • 3D representations of IPR & engagers
  • Tooth charts & instructions for every step
  • Missing teeth & placed engagers on chart
  • Treatment animation
  • Embedded link to ClearComm
  • Better Mac support
  • Improved interface

Check it out:

Pro Tip: If the models occasionally flicker, you can fix it by adjusting your settings. In Adobe Reader, go to Preferences > 3D & Multimedia and change Optimization Scheme for Low Framerate to None.

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Tech Tip: Why does my patient still have a gap after treatment?

Occasionally, you may notice a small gap between the central incisors even after the patient has completed aligner treatment. This includes the so called "black triangles" that occur when the interdental gingiva doesn't fully fill the void between teeth at the gingival margin. If your patient read their informed consent & agreement form, they'll be aware of possible outcomes like this ahead of time. Although it doesn't happen often, it can be a disappointment for a patient who just went through months of treatment.

Black triangles can happen with any method of alignment, including traditional braces. This is a natural consequence of alignment correction, so it can't always be avoided. If a gap remains after the aligners come off, additional orthodontic treatment may be required to close it. Here are a few solutions that might work for your patient:

  • In the case of black triangles, perform IPR at the point of contact to allow the affected teeth to come together.
  • Restorative therapy might be in order to fill smaller gaps caused by insufficient interdental gingiva.
  • Reconstructive periodontal therapy, also known as "periodontal plastic surgery", may also be considered to increase interdental papilla height and volume to fill the black triangle void.
  • The digital power chain is a valuable technique that eliminates gaps by bringing the teeth closer together. If you have diastemata, you don't have to rely on traditional metal braces to do this! ClearCorrect has its own power chain that doesn't require elastics.

Before we go...

Just a friendly reminder - we don't accept stone models in your case submission materials; we only need the PVS impressions and some high quality photographs. If you'd like, you can even send us X-Rays, although it's not required.

Actually, one more thing...

A few doctors have told us they're having trouble viewing our treatment setups while using Google Chrome instead of Internet Explorer. Here's an easy troubleshooting solution that's been helpful to many of you.

  • Make sure you the have newest version of Adobe Reader (currently 11.0.06).
  • Type "chrome://plugins" into the search bar (without the quotes).
  • You'll see a list of plugins. Find the one labelled "Chrome PDF viewer" and deactivate it.
  • Close Chrome and bring it back up.

And that should do it! If you were having difficulty reading Treatment Setups in Google Chrome and this helped, let us know. As always, we love to hear from our providers, so if you have a question or a suggestion you'd like featured in one of our tech tips, drop us a line.

Tech Tip: Common questions and concerns

We often survey our customer service representatives to get an idea of what our providers are interested in knowing. Below is a short list of some of the most commonly raised concerns and questions.

What can I do to prevent my patient's engagers from popping off?

From the wiki:

There are several possible causes for why an engager might fall off - usually while removing the aligner - although the most common cause is that the composite is not fully adhering to the tooth.

Read more...

My patient's front teeth occlude properly, but the posteriors don't.

From the wiki:

There are many possible causes of this situation. This phenomenon is fairly common with clear aligners, and it’s usually temporary. It can be caused by the “hinging” action of the jaw.

Read more...

Can I hand strip during treatment if it's not recommended by ClearCorrect?

From the wiki:

Take IPR into your own hands! The recommended amounts of IPR in the treatment setup and treatment plan are for guidance only. You are the doctor, and are the one ultimately treating the patient. Small amounts of unscheduled IPR can get treatment back on track much quicker than submitting a lengthy case revision.

Read more...

Why is it so critical for me to submit good photos if you have the impressions?

From the wiki:

When submitting a case to us, you'll need to take photos of your patient from eight very specific angles. We use these photos both to identify the patient, as well as to make some decisions regarding the fullness of the lips in profile.

Read more...

Will ClearCorrect return my impression trays?

No, we don't return impression trays or other records. As our terms & conditions state:

“Records submitted to ClearCorrect become the property of ClearCorrect and will not be returned to Doctor.”

If you're especially fond of your impression trays, don't forget that we accept intraoral scans from most major scanners on the market! If you don't have an intraoral scanner, send us disposable impression trays instead. If there are any questions you'd like addressed in one of our future tech tips, we'd love to hear from you!

Guess who's back?

Just in case you didn't catch our recently released tour video, here it is again! Take a two minute tour of our facility and see what goes on behind the scenes. Click the player to be taken to the video.

 

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ClearCorrect offers free retainers

Just a friendly reminder - one of the unique perks ClearCorrect offers is a pair of free retainers at the end of any case.

After a patient is finished with their clear aligner treatment, it's important they get (and wear) their retainers to prevent relapse. Make sure to order your free retainers within a year of receiving your final phase so you don't miss out! If your patient needs a new set of retainers after they've used up the free ones, you can submit a new "Retainer" case on ClearComm. Just remember that when you order your free retainers, it automatically closes your case, so make sure your patient is happy with their teeth. If you decide later on that more tooth movement is necessary, you can just submit a new case.

A few months ago, we released a tech tip discussing the importance of proper retainer use.We regularly get questions about how long patients should wear their retainers. Let's take a look at what Dr. Mah has to say:

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How do you talk to your patients about wearing their retainers? Drop us a line and give us your ideas, and we will use them in a future tech tip.

Tech Tip: avoiding case revisions

 

As we've mentioned in previous tech tips, you can avoid unproductive case revisions by checking for tight contacts on a regular basis. Teeth can't move when they're jammed up against other teeth. By reducing the enamel a bit at the point of contact, you can free up space for the teeth to move.

If you're looking to avoid a lengthy case revision, consider the following steps:

  • Use a diamond strip to handstrip between areas of tight contact. Our IPR tutorial video shows you exactly how to do this. 
  • Confirm your patient has been compliant in wearing their aligners. It's critical they wear them at least 22 hours a day to maintain osteoclastic activity. Compliance checkpoints can be found on the treatment plan on treatments with IPR.
  • If rotations are not occurring as planned and you have verified there are no tight contacts, use an orthodontic retention dimple plier to add pressure on that tooth, pushing it in the direction it needs to rotate.
  • If you encounter a stubborn tooth that won't extrude, see our simple guide to extruding with auxiliaries.
  • Request a replacement aligner from us and keep your patient in the same step for another three weeks to complete the movement, then continue on with the next scheduled step of treatment.
If these solutions don't work, then it might be time to request a revision. Make sure to call us first and reference our Wiki to ensure you've exhausted all possible troubleshooting options. Don't forget: there is no fee to request a revision, but if the result of the revision requires upgrading your treatment option, you'll need to pay the difference.

Reference Links:

Do you have your own ideas for avoiding a case revision, or have experience troubleshooting? Drop us a line in the comment section below, and we'll share your experience in a future tech tip!

Tech tip: non-compliance - part 2

Two weeks ago, we gave you a few tips on how to spot non-compliant patients. Today, our Chief Technology Officer, Dr. James Mah, offers up his three keys for ensuring compliance:

  1. Education
  2. Motivation
  3. Verification
Dr. James Mah"As far as education, clinicians should discuss the basics of tooth movement and the importance of wear time. Relatively continuous pressure to teeth is required for effective tooth movement. Many patients don't know this and fail to achieve the required hours. Compare a patient that wears aligners 20 hours per day to another that wears them 8 hours per day: the first patient will have 2.5 times the continuous forces as the other, and that will be reflected in the resultant tooth movement rates.

Motivation for aligner patients is most often verbal praise for a job well done. In my office, we provide 'wooden nickel tokens' as rewards for cooperation. Patients can trade the tokens for gift certificates and other rewards. Additionally, we remind them that orthodontics is serious business and continually remind them that the result will be well worth the effort.

In situations where compliance is lacking, we often need to have a frank discussion with the patient. Even before treatment begins, I let patients know that treatment success is a team effort between them and my office. I simply state that 50% of their success is up to me and the other 50% is up to them. If they don't live up to their end, we have to accept more compromises. In addition, decreased wear often results in no net tooth movement. When the aligner is worn, teeth begin to move toward the correction but when it is removed the tooth moves back to its original position. I ask patients "Why pay me to rock your teeth back and forth?"

On the topic of verification, first I warn them from the first aligner on that we'll be checking wear "under the microscope" and if I find it lacking, I'll be brutally honest with them. This makes it easier when I come down hard on a patient for non-compliance. I can then say 'I told you from the beginning that I'll be checking.'"

Finally, if you're looking for a few more tips on how to discreetly verify whether a patient is wearing their aligner, keep the following things in mind:

  • Well worn aligners fit loosely and will almost fall out on their own. If there are any tight spots or binding, you can be clear the aligner has not been worn enough.
  • Ask patients to bring in their current aligners. A lot of non-compliant patients will "forget" their aligners at home and encourage their clinician to dispense the next set.
  • Well worn aligners will feature discoloration and the occlusal surfaces will show signs of wear.
  • The next aligner will fit tightly, but won't be too difficult to get in.

And that's it! If you have any tips of your own you'd like to share, we'd love to hear from you!

Until next time...

Tech tip: non-compliant patients

Compliance is the most common reason things go off the rails during treatment. As much as you'd like to give your patients the benefit of the doubt, sometimes you might need to check for compliance yourselves. Here's a few ways to determine if your patient has been wearing their aligner properly.

  • Your patient comes to the appointment not wearing their current aligner.  This is a big red flag. The patient needs to know that ClearCorrect aligner treatment won't work unless they diligently wear their aligners for at least 22 hours a day. If they aren't wearing their current trays when they arrive at their appointment, your patient may not be wearing their aligner properly.
  • Aligner is tight after 3 weeks of wear, or is still hard to remove or insert.  After three weeks of wear, the aligners should sit loose on their respective arches and should be easily removable. 
  • A clean aligner is a neglected aligner.  Anything that gets put in a human mouth for three weeks is not going to come back out looking clean. If your patient has suspiciously clean trays when they come to their appointment, it's a good bet they haven't been wearing them.
  • Frequent missed or rescheduled appointments.  They're probably not wearing their aligners as recommended.
  • Spaces between teeth made by IPR don't close when expected. When you look at your phase instructions and gaps between teeth don't decrease as they should, your patient probably isn't wearing their aligners properly. There are compliance checkpoints in your treatment plans telling you exactly when to check for closed gaps.
  • Aligners gradually fit worse as treatment progresses. If the fit of the aligners progressively worsens over time, your patient might not be wearing their trays as prescribed. Non-compliant patients are the most common cause of poor fitting aligners.

Here's what to do if you have a non-compliant patient:

  • Show them what their teeth will look like if they wear their aligners properly! Get them to daydream about what a nice smile they'll have after they've finished their treatment. Suddenly wearing those aligners doesn't look so bad, does it?

  • Don't let up!  Extend the time they have to wear their current aligners by a couple weeks. They'll learn that the more diligently they wear their aligners, the less time they have to be in treatment.
  • Remind them that there are no refunds. Why pay all that money and not get the results they want? 

If you have any tips or techniques for ensuring patient compliance, we'd love to hear from you! Share what works for you and we'll share them in a future tech tip.

Tech Tip: Loose or mobile teeth

Here's a question we've gotten from a few doctors new to orthodontics:

I have a patient that is in the middle of treatment and I noticed that some of the teeth are mobile or feel loose. The patient did not have any periodontal problems before treatment and keeps their teeth clean. Should I stop treatment until the mobility goes away or should I not be concerned about this and continue with aligner treatment?

Dr. Mah responds:

Dr. James Mah

Tooth mobility of ~1mm is relatively common during active tooth movement. The tooth socket is being remodeled to allow for the tooth's movement. During remodeling, it is slightly enlarged.

In addition, the periodontal ligament is undergoing tremendous remodeling in phases of resorption and reformation. During this time, it is not as taut and does not function as well, resulting in slight mobility.

Also, the supporting bone has a dense cortical border with trabecular bone in between. The significance of the trabecular bone is that it is not homogenous. Rather, its appearance is like "Swiss Cheese" with spaces between the supporting bone scaffolding. As a tooth is moved through bone, it will pass through the bone scaffolding and the spaces. In the latter, there may be more mobility.

Having said this, clinicians should be on the lookout for occlusal interferences, periodontal disease, endodontic problems, excessive root shortening and pathology during orthodontic tooth movement. Mobility of greater than 1mm should be further evaluated for any possibility of these other problems. Most commonly, excess mobility is due to occlusal interferences.

Tech Tip: How to pick a treatment option

One of the most common questions we get from doctors is "How do I know which case type to choose?"

As you may know, we offer three treatment options:

  • Limited 6 (up to 6 steps)
  • Limited 12 (up to 12 steps)
  • Unlimited (as many steps as needed, with up to 3 years of revisions)

Working with Dr. Mah, we've prepared this simple chart to help you predict which treatment option might be best for your case:

 

If you're still not sure where your case falls, it's always safest to err on the side of caution and give yourself a little wiggle room. You can't go wrong choosing Unlimited.

You can also consult our case parameters to determine how well-suited your patient is for treatment with clear aligners.

Please let us know if you have any feedback or questions. Have a great weekend!