In this week's edition, a ClearCorrect provider shares one of his favorite techniques.
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 At this point, the impressions were about 6 months out-of-date, and I was worried about the aligners' fit.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.