Tech Tip: Patient objections & challenges

Patients can have all sorts of objections and challenges to doing clear aligner treatment. Here are some suggestions for addressing these issues so that your patients can experience the benefits of clear aligners.

Objections

“The aligners are uncomfortable” doctor and patient chair.png

Other than the temporary discomfort caused by tooth movement, a well-fitting aligner will only be uncomfortable if there is a rough edge, which can be smoothed at home with a fingernail file, or at the office by an assistant.

“They’ll make me talk funny”

Some patients develop a temporary lisp when they first try aligners, but this usually goes away very quickly.

“They cost too much money”

A new and beautiful smile should be a highly valued aspect of one’s appearance and everyone must determine that value on his or her own. Since orthodontic treatment is considered a time and materials intensive procedure, it is reasonably priced in a range where most patients appreciate the opportunity to make payment arrangements with the practice.

“I don’t like the little bumps (engagers)"

In many cases, the number of engagers can be reduced. However, if the patient requests to avoid the use of engagers altogether, they must accept that the treatment may take longer and specific movements may be more difficult to accomplish.

“I don’t want to have IPR done on my teeth”

If a patient refuses IPR, the doctor must consider other methods for creating the required amount of space, such as expansion or extractions. You can explain to the patient the difference between IPR with a handpiece and manually with a diamond strip. Some patients are apprehensive because of the dental handpiece and may accept other manual approaches to IPR. 

“I don’t think I can wear them 22 hours a day"

If the patient can't or won't wear the aligners 22 hours a day, both the doctor and patient must agree upon how many hours of wear will be acceptable to each party, with the understanding that the treatment may take longer or be less effective. If an agreement cannot be made, they can consider other methods for correcting the malocclusion, such as traditional braces.

Challenges

Financing is one of the top challenges for patients to start treatment. Offering a patient financing solution in your office is a great way to make treatment more affordable. Offering budget friendly payment options is another way to help. Here are some options that may be helpful to you:

  • Free exams and consultations
  • Down payment, interest-free monthly payment arrangements that are acceptable to both patient and the practice
  • Third party financing, such as beWell by FTL Finance
  • Credit cards with  or without a monthly Autopay feature
  • Health Saving Accounts
  • Split down payments
  • Extended monthly payment option with interest

Length of treatment can be a concern for some patients. While you might know that treatment with clear aligners is usually shorter, more affordable and aesthetic than traditional braces, your patient may not. Here are some suggestions for resolving this objection:

  • Clear aligner treatment may be faster than the alternative (traditional braces)
  • The length of treatment is primarily determined by the treatment goals; if treatment length is a serious objection, revise the treatment goals

Pregnancy Except during periods of nausea and vomiting, a pregnant woman can wear her aligners without any negative consequences.

Patients who travel constantly (military, jobs that require travel, college students, etc.) When it is inconvenient or impossible for the patient to be near the doctor’s office for visits, the patient can continue to wear stages of the aligners until they can return for a checkup or delivery of new aligners. 

Clear aligner benefits - talking points

Talking to your patient about clear aligners will be different with each case. Some patients know they want to straighten their teeth, and know they don’t want traditional braces. However, it’s not every day a patient like that comes through the door.

The truth is, while the majority of your patients could benefit in some way from straighter teeth, most of them don’t know it. Some of these benefits and advantages are bound to resonate more than others.

Following are some sample talking points about clear aligners that you and your staff can use to bring up or talk to patients about clear aligner treatment.

The esthetic angle patient and doctor.png

“How would you rate your smile on a scale of 1-10?"

"A lot of our patients want just want a perfect, beautiful smile, and clear aligners are a great way to get teeth into their proper position.”

“Did you know that your facial structure can be affected by teeth that are misaligned? You can minimize these effects by preventing and correcting misaligned teeth with clear aligners.”

“Did you know that a beautiful smile is associated with good wealth and well-being? Clear aligners are a simple option for correcting teeth that are misaligned and without anyone noticing that you’re in treatment.”

“Clear aligners have social advantages – people form strong impressions of each other within a few seconds of meeting, with a focus on the individual’s eyes and mouth. With a straight and beautiful smile you can make great new impressions.”

The health angle

“Did you know that misaligned teeth can cause you all sorts of dental & facial problems? Clear aligners are a simple way to fix your teeth without people even knowing you’re in treatment.”

“Clear aligners can help improve the function of your teeth so that they fit together naturally, interfere with each other less and it can even be easier to chew food & it doesn’t get stuck in your teeth as much.”

“Teeth wear down over time regardless but did you know that it accelerates for teeth that are not properly aligned? Clear aligners can help correct misaligned teeth and help with graceful aging.”

The financial angle

“I see that you have ____ (issue). Did you know that fixing your teeth today is less expensive than repairing potential damage in the future if left untreated?”

“Straightening your teeth with clear aligners could help prevent expensive complications like premature wear, receding gums, loss of attachment and loss of bone support.”

The "it's so easy, why not just do it" angle

“This system is a series of comfortable, removable, clear trays that replaces traditional braces and wires attached to your teeth.”

The "if you're already thinking about doing it, do it here" angle

“Our practice is one of the premier offices offering clear aligners to patients in our community.”

 

For more successful actions on prioritizing aligners in your practice, check out our checklist for clear aligner success.

Tech Tip: Dental prosthetics and implants

Although patients with any of the conditions listed below can be treated with clear aligners, it can make treatment more complex. Be sure and indicate in your prescription form if you are treating a patient with any of these conditions. Here are some of the reasons for added complexity:

  • Crowns usually can't retain engagers
  • Bridges can create undercuts that may make it difficult to insert or remove the aligners due to too much retention. 
  • Dentures are designed to fit together with the opposing arch. If any of the teeth move, the dentures will probably need to be replaced or adjusted.
  • Partial dentures will most likely need to be replaced, because moving teeth in anarch with a partial denture can cause it to not fit. If you want to proceed with treating a patient with a partial denture, then you will need to take an impression or intraoral scan without the partial. We would advise not to wear the partial while in treatment, as it could interfere with movements.
  • Implants cannot be moved because they are fused to the bone. Make sure you have noted all implants in your prescription form so that no movement is planned for that tooth, putting the implant at risk.

Tech Tip: The three legs of a clear aligner system

Obviously, malocclusions are very different—consequently, aligner treatments are as diverse and complicated as the presenting malocclusions. Varying treatment goals, patient compliance, and preferences of the patient and clinician further compound the situation. 

Because clear aligners are highly customized, it is important to recognize that a clear aligner system consists of more than a single appliance. Rather the system is analogous to a three-legged stool whose legs are: 

  1. The dentist
  2. The aligners 
  3. The auxiliaries

Each component contributes to the system as a whole to support effective treatment of the wide range of malocclusions that present. The first leg is the dentist:

  • Properly trained and experienced in clear aligner treatment
  • Selects prospective patients who will commit to full compliance
  • Submits adequate patient information, records, and a detailed treatment plan that is designed by the treating doctor
  • Monitors the patient’s treatment progress and recognizes when the progress is not as expected
  • Determines if auxiliaries are required
  • Able to respond to issues causing a delay in the treatment progress
  • Adequately provides a retention strategy according to the treatment circumstances

The second leg is the aligners themselves:

  • Preferably a system that is able to provide quality treatment for any malocclusion, ranging from limited, cosmetic goals to full comprehensive corrections
  • Made from material capable of meeting all of the needs of a long term treatment
  • Combined with systems designed to enhance the substance and predictability of the aligners’ capabilities

The third leg includes the auxiliaries:

  • This includes ChewiesOutie toolsengagerselasticsexpandersdistalizersTADs, etc.
  • Auxiliaries are utilized before, during, or after the aligner treatment to effect movements or changes the aligners are not capable of providing by themselves
  • These devices and techniques supplement and enhance the performance of the aligners
  • It is the doctor’s responsibility to determine when to use these devices and which ones to use.

Tech Tip: Seating Aligners

chewies.jpg

Often, when delivering a new aligner or when aligners fall off track a little, utilizing an accessory to help seat the aligner into full and proper fit is a good idea.

Chewies, plastic wafers, or even a plastic saliva evacuator tip can be used by the patient as an accessory to help seat the aligners. With the aligners on the teeth as far as they can go, the patient simply places an accessory between the upper and lower aligners and gently, but firmly, bites on the accessory to push the aligner down further on the teeth.

wafers.jpg

Chewies are a spongy plastic device that looks like a small cotton roll. Wafers are thin plastic devices in the shape of a horseshoe that conforms to the full dental arch. The plastic saliva evacuator tip is a short tube used by the dentist during an intraoral dental procedure to remove saliva from the mouth, but it can also be used by the aligner patient to help seat their aligners.

Chewies can be purchased from our online store

Tech tip: Preparing your practice

For a practice that's getting ready to submit their first clear aligner case, we wanted to provide some guidance on preparing and setting up your practice for delivery. We've taken this section from our checklist for clear aligner success, covering the phyisical items you'll need as well as the instructions on some of the basic procedures. 

Prepare your practice

  • Gather supplies. You’ll need a way to take and upload high-quality photos.
    • Digital camera or smartphone
    • Mirrors for buccal and arch photosdigital camera.jpg
    To capture your patients’ dentition, you’ll also need an intraoral scanner or: 
    • PVS impression material
    • Plastic impression trays
    We don’t accept alginate impressions, stone models, or metal impression trays, nor do we return plastic impression trays.
  • Prepare to place engagers. You might not need this immediately, but as you move into more complex cases, you’ll probably need to place engagers. You can get supplies from store.clearcorrect.com or another vendor. See How to Place Engagers video found in our help center.
  • Prepare to perform IPR. You’ll also probably eventually need supplies for IPR,BIG_IPR_grande.pngavailable from store.clearcorrect.com and other vendors. See How to Perform IPR video found in our help center.
  • Set pricing. Typical patient costs for aligner treatment range from $1,500 to $8,000, depending on the complexity of treatment and what the market will bear. Be sure to allow yourself a sustainable proft margin. Choosing Unlimited treatment keeps costs predictable. Choosing Flex can save money upfront, but allow headroom to accommodate revisions, replacements, and retainers—or prepare your patient for possible future costs.
  • Register for an e-course or live workshop at store.clearcorrect.com. This isn’t required, but we highly recommend it. ClearCorrect offers CE credit for a range of courses on topics related to clear aligners. These courses answer many of the most common questions that our support staff receives. Your staff can take any e-course you take at no additional cost, and they can accompany you to live workshops at a reduced rate.

Tech tip: Dental hygienists' role

One of the topics covered in our checklist for clear aligner success is how your dental hygienists can help you promote clear aligners.

Dental hygienists are in a unique position to identify potential clear aligner patients and initiate a conversation about clear aligners before turning things over to you. A hygienist that's educated thoroughly on the numerous benefits of orthodontics can do a lot of the sales work. They can:

  • Identify conditions that may benefit from orthodontic correction
  • Identify symptoms of occlusal disease
  • Educate patients about how correcting malocclusion can improve oral health

We’ve assembled this video playlist with the information your hygienist needs to know about clear aligners:

Hygienists may also find this guide to the benefits of correcting malocclusion helpful.

You can find more on staff roles in relation to clear aligners in our Practice building e-course, available through our online store.

practice building.png

Tech tip: Pricing and profitability

In a recent tip, we shared our checklist for clear aligner success, which touches briefly on the topic of setting prices in your practice.

The checklist was created for our practice building e-course, which provides further details regarding pricing and profitability. Here's a taste:

Doctors often ask us: “How much should I charge for clear aligner treatment?” It’s not our place to tell doctors how to run their business, but we can share some suggestions.

Aligner treatment can involve anywhere from a couple of aligners to fifty or more. Instead of calculating a unique fee for each patient based on the number of initial aligners plus an additional cost to cover estimated future revisions, replacements, and retainers, Dr. Ken Fischer recommends a simple two-tier pricing strategy:

  • One fee for simple cases with short treatment times
    • (often handled with Flex)
  • A higher fee for complex cases with longer treatment times
    • (often handled with Unlimited)

Unless a dental service organization or group practice sets prices for you, each doctor (with their accountant or financial advisor, if applicable) must determine how much to charge for services. Whether you’re providing an occlusal composite, a prophy, or orthodontic treatment, you need to set your treatment fees so that the practice's expenses (lab fee, rent, utilities, payroll, etc.) can be covered while allowing yourself a healthy profit.

Because these variables can change from practice to practice, one doctor’s fee for a “simple” case may be set at $,1500 and another’s at $2,500. One doctor’s fee for an “complex” case might be set at $3,000 while another’s is at $8,000. The important thing to remember is to set the fee based upon the value of the service provided, not just the cost of the lab fees or or materials used.

Once the fee is determined, we recommend offering the patient a variety of payment options:

  • Paid-in-full (which may include a "bookkeeping" discount)
  • Down payment with following monthly payments
  • Monthly payment plan (number of months limited to the anticipated treatment time excluding the retention phase)
  • Securing financing through a 3rd party provider
  • Or any other plan (custom or otherwise) that is favorable to the practice and the patient.

practice building.png

Check out our practice building e-course, available on our online store.

Tech tip: Patient photos and the occlusal plane

There are a number of reasons ClearCorrect requires patient photos. One of these is to accurately orient the patient's occlusal plane. 

The occlusal plane is an imaginary curved plane formed by the incisal edges of the anterior teeth and the occlusal surfaces of the posterior teeth. 

Occlusal plane.png

The angle of the occlusal plane varies from patient to patient. After scanning impressions the technicians must attempt to accurately orient the patient's occlusal plane before staging treatment from your prescription.

Without a photo of the patient smiling, the models may be oriented with the occlusal plane too flat or excessively tipped, causing the maxillary incisors to look like they need to be intruded or extruded. Note in the images below the difference when the occlusal plane is calibrated.

occlusal 2.jpgocclusal 3.jpg

For further information on occlusal planes and digital treatment planning, check out the online article "Importance of the Occlusal Plane in Virtual Treatment Planning" by Dr. David Paquette. 

Tech Tip: Best practices for treatment setups

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We've put together a summary of best practices for reviewing and approving a treatment setup. This guide covers recommendations on what you can verify, review and communicate as well as treatment adjustment options.

1. Compare to patient photos to confirm that the software has accurately captured the:

  • Articulation of the models and bite registration
  • Midline relationship
  • Overjet 
  • Overbite
  • Canine and molar relationships
  • Shape of teeth 

2. Carefully review the subsequent steps to verify the planned tooth movements are safe and effective.

Treatment Setup 2.png

3. Verify that any recommended IPR and engagers are sufficient to achieve your goals.

Here are some adjustments you can make, depending on the patient age, dentition and  ease or complexity of treatment:

  • You can slow down difficult movements to help roots stay upright and translate
  • You can adjust the wear schedule to 1, 2 or 3 weeks (1 week wear schedules are often done in combination with accelerated tooth movement technologies)
  • You can adjust your engager preferences
    • Remove or reduce engagers
    • Request vertical or horizontal engagers
    • Specify when to place or remove engagers
    • Add engagers to increase aligner retention (short clinical crowns)
  • You can adjust your IPR preferences
    • Schedule IPR for specific stages
    • Adjust the scheduled amount between 0.1 and 0.3 mm.

You can let the technician know if you are:

  1. Extracting a tooth
  2. Using class II correction techniques
  3. Using any other auxiliaries, such as:
    • Buttons and elastics for extrusions and/or rotations
    • Class II correctors (such as TAD's, Forsus, coils/springs, etc).

Note: If you find yourself frequently requesting standard changes to treatment setups (for example, "add overcorrection" or "end with a digital powerchain"), the best place to do that is on your case submission form. 

When you are done evaluating a treatment setup, you have four options:

  1. Approve the setup, select a price option and start the case
  2. Decline the setup and ask for changes
  3. Decline the setup and submit new impressions or intraoral scans
  4. Decline the setup and cancel the case

disapproving-setup.png

If you want to make an adjustment, click "disapprove" and let us know what you want to do. Our technicians will do their best to make any changes you request and upload a new version for your approval within a few days. 

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If you are inclined to show the patient the treatment setup, you can show them in your office or use the "share link" option to copy the URL and send it to them.