Tech tip: Fitting & tracking issues

How can I tell whether an aligner fits?

A properly fitting aligner should cover the teeth and fit snugly against the patient’s teeth. It will probably feel a little tight at first.

  • The aligner should usually cover the gingival by at least 0–2 millimeters. (Aligners may be trimmed differently to compensate for undercuts, black triangles, recession, bridges, etc.)
  • The incisal edges of the teeth should fit flush against the aligner without any gaps.
  • The aligner should fit snugly over the distal surfaces of the rearmost molars, if the aligner extends that far back.


Properly fitting aligners

Fitting issues

There are a few possible causes for fitting problems:

  • If the first step doesn't fit, the most likely cause is an inaccurate 3D model. This can be caused by distortions in the initial impressions or scans.
  • If the fit of the aligners gets worse over time, the teeth may not be "tracking"—in other words, the aligners are progressing as originally planned in the treatment setup, but the actual teeth aren't keeping up due to lack of space or insufficient pressure.
  • In rare circumstances, an aligner may be distorted due to physical damage or a manufacturing defect.

Some common types of fitting issues are shown below. Click a photo for detailed troubleshooting information.

Incisal gaps 


Aligners that are too big or too small


Aligners that fit on only one side

Tracking issues

Even if the aligners do appear to fit comfortably, that doesn't guarantee that the teeth are actually moving as intended. Here are some tips for identifying unseen tracking issues before the treatment goes too far off the rails:

  • Any patient non-compliance can lead to tracking issues. Educate your patient on the importance of wearing their aligners at least 22 hours per day. Signs of non-compliance include missed appointments, unusually clean aligners, and a persistent tight fit after weeks of wear. Make sure your patients know they should contact you immediately if their aligners no longer fit.
  • Saliva buildup or saliva bubbles inside the aligner often indicates that there is a significant gap between the aligner and the teeth. This will most likely be seen at the trim line.
  • Blanching of tissues indicates soft tissue impingement. This could be the result of inaccurate capture of these areas in the impression or the result of a frenum that extends towards the gingival margins.
  • If the aligners are slightly ill-fitting when you give them to your patient, but the patient calls back a few days later saying that they now fit, don't rely on that self-assessment. Do a follow-up visit to confirm the quality of the fit before advancing to the next step.
  • Even if the aligners are fitting during check-up appointments, you should check the treatment setup and paperwork to see which teeth are moving and if those teeth appear to be on course. If you see that a tooth is not moving as planned, don't wait, take immediate action. If you continue with treatment in hopes that it will correct itself later on, it may get worse.

We hope you found this information helpful!

Looking for something?

We have a great online store filled with useful tools to help you in treating your patients with clear aligners. Everything from IPR Kits and Chewies to Webinars. Check out our store at store.clearcorrect.com.

Until next time…

Tech Tip: Video - How to Take Photos & X-rays

We've created a video giving some helpful tips on how to take good photos of patients' teeth before submitting a case to ClearCorrect. Check it out!

We hope you found this video helpful! Feel free to check out our Help Center which is filled with useful tips, tricks and information to help you in treating your patients with ClearCorrect.

Until next time...

Tech Tip: Support Tips

We know that occasionally you can run into issues during treatment (aligner errors, a rotation not occurring as planned, fitting issues, occlusal gaps, etc.)

Our support representatives are here to assist you with any trouble you run into. We thought we would offer up some tips to assist you in getting your issue resolved as quickly and efficiently as possible.

Take a picture

We believe that sometimes a picture is worth a thousand words. Taking a picture of the problem you're having and sending it to one of our experienced support representatives can speed up the process and makes a huge difference in being able to resolve issues with certainty.

We'll need a close up clear picture of the occlusal, right and left lateral views of the arch in question both with and without the aligners.

So, if you can, take a picture of the problem you're having and send it to support@clearcorrect.com.

Give support all the information

When getting assistance from a support rep, they need to know as much information about the issue you're having as possible in order to better assist you. When you send in a support request be sure to give the following information:

  • Verify the step and case # marked on the aligner that the patient is trying on.
  • Confirming when and what step the issue started.
  • Was there any troubleshooting already done to correct the issue?
  • If yes, what troubleshooting techniques did you already try?
  • Is the patient compliant?

Fitting issues

Before you call support about any fitting issues, you may want to review the options you have available to you first:

  • Checking and breaking tight contacts in the area where the fitting issue is present.
  • If there are difficult movements present in the area with the fitting issue you can try backtracking with a fresh aligner, dimples, auxillaries, and chewies to get it back on track.
  • Reiterating patient compliance.

We hope you found this information useful!

Until next time...  

2015: Year in Review

Happy New Year!

2015 was a fantastic year and we've got an even better year planned for 2016 (our tenth anniversary). In case you missed them, here are a few of the highlights of 2015.

    

  • We went international! ClearCorrect is now available in Canada, Australia, and New Zealand, with more countries coming soon.

    

  • We created our new and improved Help Center, including live chat with support representatives directly from ClearComm.

  • We introduced several new features, including:
    • You're not obligated to pay until you approve a treatment setup
    • You can ask us to recommend a case type
    • We're shipping up to 12 steps at a time
    • You can customize your wear schedule
    • We added a number of new features for retainers, including making multiple sets of retainers available for purchase
    • Discounts are available for case submissions using intraoral scans
    • Volume discounts start at just 5 cases per quarter
    • Limited revisions are a flat rate of $120 plus shipping, instead of $240 per phase
    • We started offering daily, weekly, or instant email notifications, so you can keep up with your cases however works best for your office.

  

Hope your 2016 is off to a great start! Until next time...

Tech Tip: Setups based on old impressions or scans

When you evaluate a treatment setup, you have four options:

  1. Approve the setup and start the case
  2. Decline the setup and ask for changes
  3. Decline the setup and submit new impressions or scans
  4. Decline the setup and cancel the case

If it's been a while since you took the impressions or scans, you’ll need to evaluate whether they’re still accurate. Only approve a setup if you’re confident it accurately represents the current position of the patient’s teeth. Otherwise, you’re likely to have fitting problems, starting with step 1.

Here's what our Chief Technology Officer, Dr. James Mah, has to say on the subject:

Dr. James MahIt is best practice to promptly revise and approve the setup as the patient's dentition may change over time. The amount of change and the time frame depends on the individual patient. The dentition is not immune to the effects of wear and aging and is more dynamic than most people appreciate.

Practically, patients may be classified in the stable group where any changes are undetectable or subtle enough that there is no effective difference over many months. These dentitions typically have all teeth present in an adult, healthy periodontium, no habits, neuromuscular problems or parafunction and no unusual amounts of dental wear/attrition. A good rule of thumb for these patients is to take new impressions/scans after three months have elapsed to avoid the possibility that changes have occurred.

On the other hand, patients may have unstable dentitions where the teeth may change sufficiently to impair fit of the aligner. A common situation is following extraction of a tooth. Adjacent teeth often shift and the opposing tooth may super-erupt. For this reason, extraction treatments with aligners almost always have the extractions performed only after the aligners are available. In situations involving extractions, there is great variation and in some patients changes over a short period of time such as 2 weeks is enough to cause the aligners to not fit.

Another group that experiences tooth shifting are patients with ongoing periodontal disease. Active periodontal disease is often associated with unintended tooth movement. It is best to manage the periodontal disease and re-evaluate to determine whether orthodontic treatment is even a possibility.

Patients that clench and grind or other situations where there may be loss of tooth structure such as bulimia may also end up with poor fitting aligners depending on the severity of the problem and the amount of resultant enamel and dentin loss.

Unfortunately, in these situations of instability, there are no general rules to follow as each patient is different with different etiologies and severity. Certainly, much is up to the discretion of the doctor but change of some degree is anticipated. For this reason, these treatments have additional complexity and the patient should be informed of the issue. If treatment is elected, the best practice of promptly revising and approving the setup is recommended, rather than allowing the teeth to potentially shift for months before approving.

We hope you found this information helpful.

Until next time...

Tech Tip: Popping TMJ

What should I do if my patient’s TMJ pops when she uses Chewies?

It's possible that the Chewies could be creating a fulcrum point in the patient's occlusal plane, resulting in joint stress and positional changes.

A conservative joint management approach is recommended:

  1. Discontinue Chewies and ask the patient to help seat the trays by pushing up/down with fingers instead.
  2. Ensure the clinical TMJ exam is complete including joint films (CBCT) and a radiologist report. (You need to rule out degenerative joint disease and pathology.)
  3. Continue to clinically monitor the patient's TMJ signs and symptoms at every visit. If pain or limitation of jaw movement is noted, consider pausing treatment and remaining in the previous step until symptoms resolve with conservative therapy (Motrin, no gum chewing, soft diet, limit wide openings, etc.).
  4. Consider a one-year TMJ radiographic examination—if there are no changes from baseline, consider a 3-5 year radiographic follow-up.

Hopefully the patient's joint popping or pain will diminish. If they do, continue on with the patient's aligner treatment. (Steps #2-4 above could also apply to aligner patients who suffer from TMD.)

Don't forget about our Help Center and support representatives—they're chock-full of useful information, and we love hearing from you.

Until next time…

Tech Tip: Video - Retention

Orthodontic treatment doesn't end when the teeth are straight—most patients will require retainers. This new video on retention discusses the options that are available, including Hawley retainers, fixed retainers, and clear retainers from ClearCorrect.

Until next time...

Tech Tip: Trim Lines

We've been getting some questions about trimming recently, so we're revisiting some of our older tech tips on the subject.

As you know, aligners need strong retention in order to move the teeth as desired.

In a 2012 study, doctors from the University of Nevada compared the retentive strength of three trimming techniques:

  • A) a scalloped margin,
  • B) a straight cut at the gingival zenith, and
  • C) a straight cut at 2 mm above the gingival zenith.

image_9

The difference between the techniques was remarkable. For clear aligners without engagers, the straight cut 2 mm from the margins was about twice as retentive as the scalloped cut. For clear aligners with engagers, the straight cut 2 mm from the margins was over four times as retentive as the scalloped cut!

image_6

Trimming the aligners differently had more of an impact than adding or removing engagers.

Based on these findings, we started trimming our aligners with a smoother contour and a larger overlap with the margins in 2013.

Because there is less risk of the aligners impinging on the unattached marginal gingiva, our aligners are more comfortable with this technique. The edge of the aligner is concealed further under patients’ lips during everyday use, so they're also a bit more discreet.

Here are answers to a couple of common questions:

Can I make custom trimming requests?

At this time, we are not able to accept custom trimming requests. We trim all aligners using the same standard protocol. If you want to customize your aligners, you can do so fairly easily in your office with a buffing wheel (like the ones available in our online store).

What should I look for if my patient complains of sore gums?

ClearCorrect aligners go through a multi-stage polishing process, so actual rough or sharp edges should be quite rare. It is fairly common, however, to experience some discomfort for the first few days wearing an aligner. This often indicates that the soft tissue is getting used to having foreign material present in the mouth. Changes to the mucosa eventually fade away when the patient stops wearing aligners.

If the gums are being impinged, one possibility is that the gingiva were not captured accurately in the impression. We prefer 4-5 millimeters of gum to be included. Incomplete impressions will affect our production models.

You may also want to look for frenum pulls.

Frenum_pull-1

These can be difficult to detect because the aligner may feel comfortable at first, but as the patient speaks and moves around, the frenum becomes irritated and ulcerated. Unfortunately this dynamic movement is not captured in the impression. Clear photographs can help to identify these. Gingival frenum pulls are rare, but when they occur, they are typically found in the maxillary premolar and midline areas. If this proves to be a problem, you may want to trim the aligner shorter in the affected areas.

We hope you found this information helpful. Don't forget—you can always visit our Help Center, which has loads of useful articles, and of course, feel free to contact any of our knowledgeable support representatives.

Until next time…

Tech Tip: Video - Checkups & Revisions

Check out the latest video in the Basics of ClearCorrect series, Checkups & Revisions. This video tells you all about tracking your patient's progress and requesting revisions under the latest terms.

While we're on the subject of revisions…

If you’re taking new impressions or scans for a revision, please remove all of the engagers first, so the 3D model will be as accurate as possible. The revised phase will include fresh templates to place new engagers, if necessary.

Until next time…

Doctor spotlight: Joe Hannah

This week, we're putting the spotlight on Dr. Joe Hannah, an orthodontist with several practices in and around Kansas City, Kansas.

Hannah_22-1

What do you like to do?

I love to practice orthodontics and see the changes that we make for our patients. I enjoy my family and spending time outside. I raise a small herd of cattle on our ranch and play some golf too.

How long have you been practicing?

This is my twenty-ninth year of practicing orthodontics.

How did you get into orthodontics?

I've been interested in dentistry since high school. A family friend inspired me to pursue dentistry.

I attended the University of Kansas for undergrad, the University of Missouri-Kansas City for my dental degree, and the University of Louisville for my residency in orthodontics.

After graduation, I went to work for a close family friend, Dr. Dick Radke. I took over the practice when he retired and this summer, Dr. Richard Hannah (Dr. Radke's grandson and my nephew), joined me in practice after completing his M.S. in orthodontics.

What made you decide to try ClearCorrect?

I signed on with ClearCorrect five years ago after a decade with a competitor's aligner system. I had frustrations with the competitor's many different options that seemed to always change. After a short webinar with ClearCorrect, I treated several cases and we never looked back! We were more than satisfied, and the lab fee was less, which appealed to me.

What do you like about ClearCorrect?

Aligner therapy has an important place in my practice, although I treat the majority of my patients with fixed appliances, including the best ceramic brackets available. To incorporate aligner therapy into my practice, I need good product support with consistent outcomes.

ClearCorrect works as well as the other system to move teeth, and it has several advantages for my patients, including the starter set that allows my patients to ease into treatment. The treatment setup allows for me to direct treatment the way that I need to and the paperwork with treatment direction is so simple for us.

My staff is extremely happy with the support we receive, both online and with our representative, who is always available for us.

We send scans for all of our patients and ClearCorrect works with many different scanning machines.

Do you have any tips you can offer our providers on your success with ClearCorrect?

One of my biggest tips for success with ClearCorrect is patient selection. This can be broken down into two parts.

First, I make sure to only choose cases in which I can expect predictable tooth movement, while also avoiding cases with blocked out or severely rotated teeth.

The second part is choosing patients who I know will be compliant. I make sure to educate any interested patients on the need for high wear compliance, both in the amount of time they need to wear the aligners (22 hours per day) and consistency in wearing the aligners.

Thanks for your time, Dr. Hannah!