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...

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.

New phase-based numbering

Aligner bag

As previously announced, we’re sending new redesigned single-page treatment plans with each phase of aligners, starting today. This is a great time to review our previous tech tip explaining the many improvements that you’ll see on the new paperwork.

One of the changes we briefly mentioned was our switch to phase-based numbering for each step. We’re making that change today as well. We didn’t go into too much detail last time, so let’s take a look at how that works now.

The basic idea is very simple. Each phase you receive already has a number. You start with Phase Zero, move on to phase 1, then phase 2, and so on. That’s not changing.

Now each step will have a number based on the phase it came in: phase 1 will include steps 1A, 1B, 1C, and 1D, phase 2 will include steps 2A, 2B, 2C, and 2D, and so on.

IPR, engagers, and Compliance Checkpoints will always be scheduled for your appointments on steps A & C of each phase. If you submit a midcourse correction while your patient is wearing phase 3, you’ll get revised models starting with step 4A.

We’re making this change for existing cases as well as new ones, so we’ve prepared this conversion chart to help you understand the changes:

Step number conversion chart

It’s really not as complicated as it looks: whenever you get a phase, you start on step A and continue through step D. That’s it.

You might also notice that we’ve added a unique QR code to each bag. It doesn’t do much yet, but we do have plans for it in the future. Oh yes, big plans. Secret plans.

Until next time...

Free two-day shipping for all new online case submissions

We improved our shipping label tracking last week, and as a side effect, a lot of folks realized that they’ve been getting something for free that they were really supposed to be paying for. Hey, we’re cool like that. Unfortunately, all good loopholes must come to an end.

As explained in our terms & conditions and our product list, the following shipping charges are included in your up-front costs:

  • one shipment to us to submit impressions for a new case
  • shipments to you for all included phases (including Phase Zero & retainers)

These shipping costs are not included in the lab fee:

  • additional shipments to us (such as new impressions for midcourse corrections)
  • shipments to you of replacement aligners
  • a one-time surcharge for shipments to Alaska, Hawaii, and offshore territories

This isn’t a new policy—we just haven’t been enforcing it very strictly. Now that we’re tracking what each shipping label is for, people can no longer print unlimited shipping labels for free. The days of walking into clubs and “making it rain” with UPS Ground shipping labels are over. (We’re looking at you, Dr. Harold “Mad Grillz” MacPhearson of Omaha, Nebraska.)

However, there is some sugar sprinkled on this donut of disappointment, and boy is it sweet:

First of all, we’re upgrading all new online case submissions to 2nd-day air shipping at no extra charge. (If you’re close to our headquarters in Houston, your impressions might still be sent via Ground if the estimated delivery time is the same or quicker.) For folks who are further away, this will shave days off your turnaround time. Just submit a case on ClearComm, and an upgraded shipping label will be generated automatically. (This change doesn’t affect aligners, which are still shipped via UPS Ground.)

Secondly, if you’re not comfortable submitting online yet, you can still get free Ground shipping labels for handwritten case submissions. Just call or email your account rep, and we’ll email or fax you a label, just like old times.

If you need shipping labels to send us anything else, print your own labels on ClearComm and take advantage of our lower shipping rates and tracking on ClearComm.

On a related note, we have heard that some doctors have had trouble uploading photos when submitting online. While we improve the photo uploading page, we’re temporarily allowing doctors to skip that step and include photos in the submission box if they have problems. If you can upload your photos, please do—it’s quicker and more accurate than matching up physical prints.

Finally, this should probably go without saying, but don’t use shipping labels more than once. If you print multiple copies of a shipping label and use them to ship multiple packages, UPS will get all confused, and there’s no telling what will happen to your valuable submission. If you need to reprint a label for legitimate reasons, it is possible. Go to the Shipments page on ClearComm, show your shipments “to ClearCorrect”, and click “Details” next to the label you want to reprint. A pop-up window will appear with tracking information and an option “View/Print Label”.

Tech Tip: What to expect when you submit a case

Since we introduced Phase Zero in September, we’ve cut our typical Phase Zero production time down to 5 business days or less. A couple of weeks ago, we made some more improvements to sync up the deliveries of Phase Zero and the treatment setup. So we’ve updated our timeline to reflect these changes. This document is the best explanation of what to expect when you submit a case.

To give you a more realistic estimate, we’re now counting shipping time to & from your office and allowing a couple of days for your Phase Zero / treatment setup evaluation. If everything goes smoothly, you can probably expect to get Phase Zero about two weeks after shipping your case submission, and Phase 1 about two and a half weeks after approving the treatment setup. Pay close attention to the red notes on the timeline: they’ll help you avoid case delays.

Remember, Phase Zero is based directly on scans of your impressions. We can't correct impression mistakes or verify that the models match your patient's teeth. That’s your job. When you make sure that Phase Zero fits on your patient's teeth, you're not just getting them started faster; you’re also physically confirming the accuracy of the 3D models used for the treatment setup. That's why it’s important to call your patient in for a Phase Zero fitting appointment before approving the setup.

This sample timeline is based on typical UPS Ground shipping times for the Southern/Central United States. Delivery times can vary significantly depending on your distance from our headquarters in Houston. Adjust your estimates accordingly:

UPS Ground shipping times to 77041

UPS Ground shipping times from 77041

Tech Tip: 5 midcourse correction myths

There are a lot of misconceptions out there about refinements & midcourse corrections. Here are some of the most common misunderstandings:

Myth #1: You can get unlimited midcourse corrections & refinements for free.

False. It is true that we don't charge a fee for refinements or midcourse corrections. However, you're still only entitled to receive the number of phases included with your case (3 for Limited, 8 for Full). If you use more than that, you'll have to pay for the extra phases. You're also responsible for the cost of shipping new impressions to us.

Myth #2: You should request a midcourse correction every time an aligner doesn't fit.

False. Most of the time, if the teeth aren't on track, it's because the patient hasn't been wearing the aligners regularly. The aligners really need to be worn 22 hours a day, every day, for best results. If your patient isn't doing that, then requesting a midcourse correction is a complete waste of time. 

Remember what a midcourse correction is: we simply make a new phase starting from the current position of the patient's teeth. You can accomplish the same thing without wasting a phase by simply backtracking to the last step that fit and reinforcing the wear schedule. For extra strength, you can make fresh aligners using the included dental models. Of course, use your professional judgement, too. If there's a difficult extrusion or intrusion that's not happening, a bracket & auxiliary technique will often be more effective than a midcourse correction.

Myth #3: You'll get a Phase Zero and treatment setup after a midcourse correction.

False. As the name implies, Phase Zero is only sent at the beginning of treatment. A midcourse correction does not change the ultimate goal for the case, so we don't generate a new setup for your approval.

Myth #4: Your patient should stop wearing aligners while waiting for a midcourse correction.

Myth #5: Your patient should keep advancing to new steps while waiting for a midcourse correction.

False and false. When you submit a midcourse correction form, we'll ask "Which steps currently fit your patient's teeth best?" Those are the aligners your patient should keep wearing to retain the position of their teeth. When you get the revised phase, give the first included step to your patient and discard any unused steps from the previous phase.

As always, if you have any questions, just ask your account rep.

Tech tip: New & improved treatment plans

In the next couple of weeks, we’re rolling out brand-new, totally redesigned treatment plans. You’re going to love this. The new paperwork adds a ton of new useful information, and really clarifies how phases work. We’ve also managed to cut it down from five pages to a single, Earth-friendly sheet of paper.

Treatment plans: funky & clunky vs. lean & green

Get comfortable, because this tech tip is probably going to be our longest one yet, and you’re going to want to know this stuff.

We’ll start at the top of the treatment plan and work our way down. (Download a sample treatment plan here if you want to follow along.)

Case information

Patient name

Nothing too surprising here. A big readable patient name is followed by the case number, the prescribing doctor, and the date that the current phase was shipped.

(By the way, if your email client usually blocks images, you’ll want to make sure to load them now. Things are about to get very visual.)

Phase graph

Phase graph

The phase graph at the top of each treatment plan gives you a quick overview of the entire case: past, present, and future.

As you know, we make our aligners one phase at a time. A standard phase includes four sets of aligners, and lasts 12 weeks. Each phase is represented as a box on this graph, segmented into four steps. (Phase Zero and the retainer are narrower because they only include one set of aligners.)

Let’s take a closer look at each section of the graph:

Past phases

Past phases

Phases that you’ve already received are represented as gray boxes on the graph.

In this example, a note under phase 3 indicates that it was shipped as a midcourse correction. Don’t worry about the little symbols in phase 1 just yet; we’ll talk about those later.

Current phase

Current phase

The current phase (the one sent with the treatment plan) is filled in green. The phase number above it is big, bold, and also green. In this example, the patient is about to start phase 5, which is also a midcourse correction.

I bet you really want to know about the triangles, square, and X on the first & third step. Just hang tight—it’ll all be clear soon.

Planned phases

Planned phases

The right side of the graph offers a glimpse into the future. Planned phases are represented as green outlines. Here we can see that the final planned phase is phase 6. It’s scheduled to ship around March 28, 2012*, followed by final retainers whenever the doctor requests them (you do request final retainers, don’t you?).

*That asterisk after the shipping date is important. Estimated ship dates are just that—estimates. They change all the time. You really want to wait to schedule appointments until you get an email notifying you that the aligners have shipped. If a patient shows up before the aligners do, no one is happy.

Also remember that this is an estimate of the ship date, not the delivery date.Depending on where you are, UPS Ground delivery can take up to 5 business days. Updated shipping date estimates and tracking numbers are available on ClearComm. Don’t hesitate to use them.

Extra phases

Extra phases

Here’s something you’ve never been able to see before: extra phases. They’re represented by light gray outlines on the graph.

As you know, a certain number of phases are included with each case (3 for Limited, 8 for Full). If a Full case has fewer than 8 phases scheduled, some unused phases are left over. Those extra phases can be used for replacements, midcourse corrections, or refinements. If some phases are still left over when you request the final retainer, they’re donated to the Phase Out program.

These new graphs should help you understand your options. For instance, if you request a midcourse correction, the treatment may use more phases than originally planned. That’s no problem if you have enough unused phases to cover the difference, but if you don’t, you’ll need to pay for the extra phases.

If you request a replacement aligner instead of making one in your office, it will “break” one of your extra phases so it can only be used to make replacements. The shaded boxin the darker gray replacement phase above represents one replacement. The note above the shaded step indicates that it was used to replace step 2A.

Phase-based numbering

Wait a minute. Step 2A?

That’s right, we’re renumbering the aligners to make it more clear which phase they belong to. Instead of steps 13, 14, 15, and 16, you’ll get 4A, 4B, 4C, and 4D.

No more mental calculations; you’ll always dispense A & B at the first appointment, and C & D at the second appointment—even after a midcourse correction.

Appointment instructions

Okay, we’re nearing the home stretch, folks. Remember those funny little symbols on the phase graph? Behold! All will be revealed.

First appointment

The sheet includes separate instructions for the first and second appointment of each phase. You’ll notice that each type of procedure is accompanied by a unique symbol:

  • Compliance Checkpoint A green teardrop represents Compliance Checkpoints.
    • When you see these, check for contact between the teeth with dental floss. If they’re not touching, your patient probably hasn’t been wearing their aligners 22 hours a day, and they might not be ready for the next step.
  • 0.2 mm IPR A red triangle represents IPR.
  • Add engager A blue square represents adding an engager
  • Remove engager A small black X represents removing an engager.
  • Extraction A large gray X represents extraction.

On the phase graph, these symbols indicate which procedures are being performed at each appointment. Now if you need to schedule more time for IPR or engagers, you’ll know in advance.

Tooth charts

On the tooth charts below the instructions, those same symbols give you an at-a-glance overview of where those procedures are being performed. If we know that a tooth is missing, we’ll delete it from the graph. The IPR triangles even change width to indicate whether you’re performing 0.1, 0.2, or 0.3 millimeters of IPR.

There’s a chart for each step, but procedures will never be recommended on step B or D of a phase (because your patient starts those steps at home).

You can also quickly see which teeth are moving in each step—they’re highlighted in green

Tooth charts

The specific movements are listed below each graph:

Tooth movements

Epilogue

Well, I think that about does it. We covered the whole treatment plan, top to bottom. As you can see, there is a lot of information packed onto that one piece of paper. Hopefully, it will seem pretty straightforward when you start to receive the new paperwork in the next few weeks.

If you want to review this tech tip later, it will be available (like all our tips) right here on our blog. Of course, you can also always contact your account rep for assistance or feedback.

I think I'm going to go have a little lie-down. Until next week…