Tech tip: More helpful tips about impressions

I know we've talked about impressions before—and recently, too—but I thought it might still be really helpful to show all of our doctors a few examples of inaccurate impressions and the distortions they cause. Nobody's more familiar with impression problems than our prescreening department, so we asked them to share some models poured up from rejected impressions so you could see examples of common problems that can occur.

Take a look:


Common impression problems

All of the impressions in this document would probably lead to inaccurate aligners that simply wouldn't fit.

So please, keep these tips in mind:

  • Use plenty of PVS material. Too much is better than too little.
  • Use the right size tray. If it's too small, the teeth can touch the edges. Make sure your tray reaches beyond the most distal tooth in the arch without touching the front teeth.
  • Don't move the material while it sets. This can cause subtle distortions that are hard to spot until you get aligners that don't fit.
  • Leave the tray in long enough. You can add an extra minute to the recommended final set time just to be safe. Use a timer to make sure you never remove an impression early.
  • Don't wait too long to add the light body. Don't let the putty or heavy body harden completely before covering it with light body and finishing the impression.

And here are our nifty impression guides and videos again, if you'd like a refresher, or if you'd like to pass them along to someone else:

One-step PVS impressions (our favorite!)

How to Take One-Step Impressions

Two-step putty impressions

How to Take Two-Step Impressions

Bonus tip!

We recommend scheduling appointments with your patient after you receive an email notifying you that their aligners have shipped. Shipping dates on treatment plans are just estimates; your patients will be very frustrated if they show up at your office and their new aligners aren't there.

That's it for me this week. As always, contact your account rep if you have any questions.

Tech tip: Track your cases & shipments online

Screenshot of case tracking on ClearComm

We've got an awesome new feature to announce: Right now, you can view details about every case you've ever started with ClearCorrect online.

Just log on to ClearComm and click Cases. You can review your patients' info, look up which parts of your case submission have passed prescreening, and find out when your patients' next phases are scheduled to ship. (Of course, as always, projected ship dates are just estimates, so don't schedule a fitting appointment until you receive notification that the aligners have shipped.)

Speaking of shipments, now you can track those on ClearComm too! You'll find tracking numbers and detailed status updates for everything we ship in the Shipments section of the website.

You can also check & update the shipping, billing, and contact information we have on file for you by clicking on My account.

Check it out at dr.clearcorrect.com, and let us know what you think.

We're still improving the website and rolling out new functionality, so some sections might move around a bit or change in the next several weeks.

If you need help logging in, email or call your account rep. Enjoy!

Until next time...

Tech tip: Empty boxes, bad impressions, and phantom packages

Empty boxes

The #1 cause of case delays is missing items. Sometimes we get case submissions with nothing but a form in an empty box. Remember, every case requires:

  1. A case submission form
  2. Upper and lower impressions (even for single-arch treatments)
  3. A bite registration
  4. Photos
  5. X-rays

Bad impressions

The #2 cause of case delays is bad impressions.

I know we've covered this topic before, but we still get a lot of unusable impressions. Believe me, our prescreeners don't enjoy rejecting impressions--it causes delays and inconvenience for everyone involved.

But we really can't lower our standards either. If we let an unclear or incomplete impression through, our 3D model will be inaccurate, and that will cause even bigger problems all the way down the line.

So please, be extra careful when you take impressions for clear aligners. Our prescreening department has put together the following tips:

  1. Use plenty of PVS material. Too much is better than too little.
  2. Use the right size tray. If it's too small, the teeth can touch the edges.
  3. Don't move the material while it sets. This can cause subtle distortions that are hard to spot until you get aligners that don't fit.
  4. Leave the tray in long enough. You can add an extra minute to the recommended final set time just to be safe. Use a timer to make sure you never remove an impression early.
  5. Don't wait too long to add the light body. Don't let the putty or heavy body harden completely before covering it with light body and finishing the impression.

There are free videos and PDF guides linked at the bottom of this email: we recommend that you share these with anyone in your office who takes impressions.

Phantom packages

Finally, our receiving department has asked me to remind you to generate a new shipping label every time you ship us a package.

If you print copies of the same label to use on multiple packages, they'll all share the same tracking number. UPS won't be able to track the package correctly (they may not ship it at all), and your materials can be lost.

That's it for this week. As always, contact your account rep if you have any questions.

Here are those impression guides I promised:

How to Take One-Step ImpressionsHow to Take Two-Step Impressions

Tech tip: Digital power chains

Today's tip comes from our own chief technical officer, Paul Dinh.

Question:

My patient is finishing his scheduled treatment, but he still has a bit of space left between some of the teeth. What should I do?

Answer:

This sounds like a good candidate for a case revision. Send us a case revision form. In the Reason for Submission section, let us know which teeth still have space between them. In the Instructions section, you can request a "digital power chain."

A "power chain" is traditionally a piece of elastic that wraps around metal braces and pulls the teeth closer together. If you request ClearCorrect's "digital power chain", we'll just adjust our 3D model to lingualize all the spaced teeth by about 0.2 mm. There's no rubber band, but the effect is similar: the teeth are pulled closer together.

If your patient's aligners are still fitting well, you don't need to take new impressions when you request your case revision. A case revision does require another phase (with probably just one or two steps), so if you're not sure whether you have unused phases remaining in the case, you may want to ask your account rep.

Tech tip: How to double-check your progress

Here's a tip from Dr. Rohini Vajaria of New York:

One tip I can offer is when the patient comes in the office for an appointment, it is helpful to do a careful clinical exam and compare the patient's progress to the ClearCorrect setups and confirm they match up.

For example, the patient's occlusion and alignment at the end of phase 1 should be compared to the phase 1 molds fabricated by ClearCorrect, and both should match each other.

This is a simple, intuitive piece of advice, but if they don't match up, it can help the clinician identify poor patient compliance, etc. and catch potential problems early.

Thanks, Dr. Vajaria.

If you have any comments or tips of your own that you'd like to share, please let us know in the comments.

Tech tip: One provider's favorite trick

In this week's edition, a ClearCorrect provider shares one of his favorite techniques.

Dr. Jose Chacon of Chicago, IL, writes:

I have what I think is a great clinical tip.

Using specially trimmed Essix retainers, I've shifted teeth to fit into an aligner that doesn't fit anymore.

A few weeks ago, I came across an interesting situation.

Long story short, a patient with spaces doesn't show for her scheduled appointment to start her ClearCorrect treatment.

Because of multiple personal and financial problems, she takes 5 months to come back after her original appointment. At this point, the impressions were about 6 months out-of-date, and I was worried about the aligners' fit. We explained to her that she would be responsible for expenses of re-booting her case if needed. We told her that most likely the aligners wouldn't fit when she made it back to the office.

Sure enough, when we finally got her back to the office, neither aligner would fit, but the lower arch was the worst. The discrepancy in the lower arch was so bad that it looked completely hopeless. The aligner was at least 5 mm off. If forced onto one side, it would not fit on the front or the opposite side.

After trying for a while, we discussed the possibility of retaking the impressions and starting all over again. But I wanted to try to avoid additional expenses, more appointments, and more waiting. I thought if I could at least trim the aligner and engage it partially, we could try fitting it 100% later.

I didn't want to damage my first aligner, so I made upper and lower Essix retainers using the #1 plastic model to reproduce the first aligner. We trimmed the plastic retainer half way the crowns' height. The upper retainer fit; the lower still didn't.

Then we trimmed away 2/3 of the lower retainer, leaving mostly the incisal and occlusal and about 1-2 mm on the lingual and buccal.

This time the lower retainer was able to be forced in place. The patient reported feeling this retainer very tight. We prescribed for her to wear these retainers/aligners 1 week full time. After a week, we tried her original aligners, and BOOM, they fit! The lower aligner was very tight, but it fit on the teeth 100%.

If aligners have not been used for a long time, and/or the teeth have moved, and aligners will not fit, then by making temporary trimmed-back 1mm-thick Essix retainers, we can make the regular aligners fit again, even if the teeth have moved a long way. So next time a patient's initial aligner doesn't fit or he hasn't worn aligners for a while and these can't fit again, I can use a trimmed clear retainer to move teeth back.

I hope this tip is useful to others. I am finding the versatility of these appliances makes them my # 1 choice for orthodontic treatment with aligners.

Thanks for the tip, Dr. Chacon. I should point out that we're just sharing one provider's tip; every patient varies, and we have not extensively tested this method for safety or accuracy, so we're not endorsing it as an official ClearCorrect technique. As always, use your own best judgement when prescribing treatment for your patients.

If you have any comments or tips of your own that you'd like to share, please let us know in the comments.

Tech tip: Marketing ideas from providers

Today we have some marketing tips sent in by providers.

Dr. Kathy DeFord writes from Papillion, Nebraska:

I had a really nice sign made for my office to advertise ClearCorrect. I forwarded the graphics from your website and had SpeedPro make a sign that shows nicely from the outside of my office, but doesn't show from the inside. From the waiting area you can look right out the window, with no advertising visible. I really like it.

Nice use of the ClearCorrect graphics, Dr. DeFord.

If you have a great idea for an ad or sign, please feel free to use any of the updated logos & images available at dr.clearcorrect.com, and share the results with us.

And don't forget that you can also order standard or customized vinyl banners directly from your account rep. We recently updated the artwork on those as well.

Dr. Alan Siegel of Phoenix, Arizona says that he tripled his aligner cases by promoting his practice with a custom folding windshield ad that he invented. Now he also prints windshield ads for other dentists as a side business.

And finally, Gibbs Hightower, our own director of public events, has a few suggestions of his own for increasing your visibility on the Internet:

  1. Spelling makes a difference. When you write about ClearCorrect, remember that there's no space between "Clear" and "Correct".
  2. Link it up. When you mention ClearCorrect or clear aligners on your website, try making the words a link to clearcorrect.com, like this: ClearCorrect. It might improve your ranking (and ours) in search results.
  3. Before & afters are priceless. There's no better marketing tool than before & after photos of your own patients. Remember to take pictures when your patients finish their treatment (get written permission first). And if you want to pass them along to us, we'd be happy to share them too. Send photos (and stories) to your account rep or beforeafter@clearcorrect.com.

Tech tip: One provider's engager trick

Today's tip comes from Dr. Mark Bentele:

One tip that I have is on placing the engagers. The engager template may not fit passively over the entire tooth if the teeth are not tracking fully. In that situation, the engager may not end up in the right place when you use the entire template. Instead, trim the template down to just the tooth with the engager and about 2/3 of the teeth on either side of it. The template will fit fully in place and the engager will be bonded correctly. This is also helpful because the engager template can be peeled away from the tooth facially rather than trying to pull it off vertically, which is more difficult.

Sounds like a good idea to us. Thanks, Dr. Bentele.

If you have any tips you'd like to share, email us or let us know in the comments.

Tech tip: Should I do IPR before impressions?

Question:

Should I perform IPR before I take impressions to submit a case to ClearCorrect?

Answer:

Generally speaking, no. We recommend taking impressions first, and waiting to perform IPR until the recommended phase, for the following reasons:

Impressions do not always capture enough detail to reproduce the spacing properly.

If more IPR than necessary is performed in one arch, you might need to perform IPR in the opposing arch to compensate. (We usually recommend IPR in just one arch, whenever possible.)

It's best to minimize the amount of time that patients have excess space between their teeth.

You may not be able to use the area where IPR was performed as a Compliance Checkpoint for some time.

Tech tip: Why are the distal edges of the aligner missing sometimes?

Question:

Sometimes I've noticed that the distal half of one of the furthest posterior teeth is missing from an aligner. Why is that?

Answer:

Sometimes we receive impressions that don't have enough detail to accurately model the distal edges of the posterior teeth. Distortion is much more prevalent in this area, because it can be difficult to make sure that the impression material completely covers the teeth in the back of the mouth.

Of course, we always prefer to receive complete, accurate impressions. But we don't want to inconvenience our providers unnecessarily either.

In some cases, we'll make an exception and process the case even though the distal surfaces of the posterior teeth are incomplete in our model. The aligners still have plenty of surface area to grip the teeth. We just trim off the potentially inaccurate area so that the case can progress without delay.

If you want to make sure that your patient's aligners fully cover the distal surfaces of all the teeth, just double-check your impressions to make sure that they're not distorted in that area, and you should be fine.