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 At this point, the impressions were about 6 months out-of-date, and I was worried about the aligners' fit.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.

Tech tip: Why aren't the posterior teeth in occlusion?

Question:

As my patient’s treatment nears its end, I’m noticing that the upper & lower anterior teeth are touching when the patient bites down, but the posterior teeth are not in occlusion. What’s going on?

Answer:

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.

Imagine placing a 1 mm sheet of flat plastic over the occlusal & incisal surfaces of the lower teeth. As the jaw closes, the posterior teeth will contact first. The patient would have to bite down firmly to get the anterior teeth to touch completely.

The same thing can happen when the teeth are covered by clear aligners. When the patient first starts wearing them, the posterior teeth are the first to contact. After wearing the aligners for a while, the teeth adjust to compensate, and before long, the patient can bite evenly with the aligners on.

The posterior teeth will usually intrude slightly to make room for the aligner, as the patient clinches his or her jaw throughout the day. Once the teeth have adjusted to the aligners, if the patient removes the aligners and bites down, the anterior teeth will make contact first and the posterior teeth probably won't quite touch.

This is not typically a big concern, however, because the posterior teeth will usually super-erupt back into normal occlusion as soon as they get a chance. After the patient has worn the final retainer for 3-6 months and the teeth are stable, the patient can switch to wearing the retainer on alternate days to give the posterior teeth freedom to move back into their normal position. Another option is to prescribe a Hawley retainer which won't interfere with occlusion, allowing the posterior teeth to super-erupt freely.

Tech tip: 4 ways to correct crowding

Question:

Which techniques should I prescribe to treat crowding?

Answer:

The simplest option is to check “only if needed” and allow our dental technicians to offer their recommendations.

If you have specific preferences for a patient's treatment, though, please let us know. At ClearCorrect, doctors are in charge. We will customize the clear aligners to carry out whatever treatment you prescribe to the best of our ability. If you don't see an option on the form, feel free to provide special instructions in the “other instructions” section.;

For patients with severe crowding, it's usually best to use a combination of techniques. For instance, proclination and expansion are more predictable together than either technique alone.

If the crowding is not too severe, however, you may be able to achieve your goals with just one of the four options (procline, expand, distalize, or IPR).

Here are the four main techniques, and when we recommend using each one:

Procline

Patient with line drawn from nose to chin
A good candidate for proclination

Proclining teeth is a useful way to give a patient fuller lips or a fuller side profile. This is recommended for older patients whose lips are a little “droopy.” This can also be desirable for people who have a flat profile.

To check if a patient needs to be proclined, draw a line from the tip of the nose to the tip of the chin on a non-smiling profile picture. In an ideal profile, the upper lip should almost touch the line and the lower lip should overlap it slightly.

If both lips are well behind the line, the patient might benefit from proclination. If both lips are well past the line, lingualizing the teeth might improve the patient's profile. (Lingualization isn't one of the standard options, but you can request it in the “other instructions” section.)

Expand

Julia Roberts
A nice wide smile

Expansion is the most common method we use to create space. It should be used when there is visible space between the posterior teeth and the cheeks when the patient smiles. A wider smile that shows more teeth can help your patients “light up the room.” Think Julia Roberts or Anne Hathaway.

Distalize

We often recommend distalizing the anterior teeth and/or premolars 1-3 mm if you want to achieve a Class I bite and improve the patient's chewing function. We don't recommend distalizing molars; they're very difficult to translate. Distalizing and mesializing less than 4 mm per quadrant keeps the movements more predictable and reduces the chance of interference with other teeth. Of course, if you want to try for more than 4 mm, you can always request that in the “other instructions” section.

IPR

We like to avoid IPR (interproximal reduction) whenever possible. However, IPR is sometimes necessary to create space for very crowded teeth to move. IPR can also be used to treat a case quickly by keeping the teeth in their current positions and just rotating them into alignment.

We usually recommend IPR when we are aligning both arches and we need to reduce the width of the teeth on one arch to get proper overjet. In this situation, IPR is usually only needed on one arch.

We can also use IPR to put premolars or canines into a Class I relationship, or to correct a midline misalignment.

As providers treat more patients, they usually get a feel for which techniques work best for them. If you have any comments, or preferred techniques and tips, please share them in the comments.

Tech tip: Redesigned, simpler forms

We've recently redesigned all of our forms to be easier to understand and faster to fill out. If you’re a ClearCorrect provider, you’ll probably want to download these new forms from ClearComm and start using them right away.

Here's a quick comparison:

Comparison of old & new ClearCorrect forms

The default options for most common cases are now highlighted in green, so you can write your prescriptions more quickly. We've also organized the case submission form into three clear sections and simplified the wording of our treatment options. You still have just as much flexibility in how you prescribe your treatment, but hopefully now it will be more clear how to do it.

Instead of a confusing case revision form, we now have separate forms for midcourse corrections, refinements, and for the rare post-approval setup revision. The quality control form has been discontinued (just talk to your account rep if you experience any issues), and we have an IPR tracking chart you can use to keep track of your patients’ IPR. Also, by popular demand, we have an optional FMX template to go along with our optional photo template.

You can get all the new forms on ClearComm at dr.clearcorrect.com. We’ve also moved our logos, images, and promotional items from our main site to ClearComm in preparation for adding more provider-exclusive content.

If you don't know your username or password for ClearComm, your account rep can help you with that. Just give us a call at (888) 331-3323 or email customerservice@clearcorrect.com. And let us know what you think of the new forms. We're always open to suggestions.

Tech tip: 3 impression tips that can save you weeks

We recently determined that 3 basic issues are accounting for over 75% of all the bad impressions that we receive. Here are the issues, and how to correct them.

Most frequent impression problems: 1) Double impression, 2) Material not fully set, 3) Posterior distortion, 4) Relining/reinserting, 5) Tray too small, 6) No light body, 7) Not enough material, 8) Missing opposing impression, 9) Material lifter off of tray

Issue #1: Double impression in 2-step material

The most common problem that we find is a double impression, which usually happens during a 2-step impression.

The easiest solution is to switch to a simpler, more reliable 1-step impression material, such as Sultan Genie VPS. We've prepared a video and a printed guide for this type of material.

If you prefer the 2-step impression process, that's okay too. Just keep an eye out for double impressions. Remember to cover the putty with a plastic sheet when you take the first impression, and to take your second impression before the first one has fully set. We have a video and printed guide for this type of impression as well.

Issue #2: Material not fully set

Our second-most common issue is material that hasn't fully set before being removed. There are two simple things you can do to prevent this problem:

  1. Set a timer and make sure to follow the directions for your material exactly.
  2. Discard the first 1 inch of material that comes out of every new mixing tip.

Issue #3: Posterior distortion

The final big issue is distortion of the most distal teeth in the impression. It can be hard to see back there, and sometimes the posterior teeth get shortchanged. There are a couple of ways to avoid this problem:

  1. Make sure that you're using a correctly-sized tray. It should extend past the last tooth in the arch without touching the gums.
  2. Before inserting the tray containing light body, add some light body directly to the occlusal and distal portion of the last tooth in the arch, ensuring that the last tooth is completely covered with material.

We hope this helps. Look for these issues before you send your impressions in, and you could save yourself & your patient the hassle of taking new impressions.