Sometimes, a new aligner won't seat correctly because a tooth hasn't moved according to plan and the engager no longer lines up with the aligner. In this situation, you don't want to force the aligner into place over the misaligned engager -- this can do more harm than good by moving the tooth in unwanted ways.
There are three different ways to deal with this situation:
- Remove the engager that's not tracking, and use the previous aligner as a template to place a new engager on that same tooth. Check for tight contacts that may be preventing movement and then have your patient continue with treatment as scheduled. Though the engager will still apply pressure to the tooth and work towards completing that difficult movement, there may be a slight gap in the aligner because that tooth will be moving a little behind schedule. (In the meantime, Chewies may help close those gaps and help your patient feel more comfortable.)
- Remove the engager that isn't tracking and continue with treatment. That particular tooth probably will not move as scheduled on the treatment plan, but that movement can be completed later with a refinement.
- If all else fails, remove the engagers from all of the teeth, take new upper and lower impressions, and submit a case revision. This may delay treatment, but it will allow us to tweak the treatment plan for that particular tooth.
Our providers always have great ideas for working with engagers, as seen here, here and here. If you have any other experience with helping engagers track, please mention them in the comments!