We sent out a survey recently asking doctors for their questions about the use of auxiliaries in clear aligner therapy. Our Clinical Advisor, Dr. Ken Fischer, has the answers.
(Note: Nothing here is absolute, we're simply offering some advice and suggestions and it should be taken as such. It's up to you to use your professional judgement on what is best for you and your patients.)
What are the main indications for auxiliaries, what are their limitations and side effects?
Auxiliaries enhance the force applied by aligners. When a tooth is not tracking with the aligner, the auxiliaries can direct pressure in the desired direction. Limitations and side effects will vary depending on the type of auxiliary and how it is applied.
How can I predict when I may need to use these systems? I would like to be able to tell a patient that these items may be used in their treatment.
Predicting the need for auxiliaries gets easier with experience. You can tell your patient that auxiliaries may be necessary when you see difficult movements such as extreme rotations, extrusions, and inter-arch corrections.
I would like to learn how to incorporate the use of auxiliaries into my cases to provide the best treatment outcomes. Do you have any recommendations?
The first step is to learn to identify difficult movements in the treatment plan. For details on how to use auxiliaries to enhance these movements, check out our article in the Help Center on this topic.
How do you best use pliers in a situation where a tooth is not moving as predicted?
Pliers create dimples in the aligners to nudge the teeth with a little extra pressure. They can be surprisingly effective. Before applying dimples, make sure there is adequate space on the opposing side of the aligner for the tooth to move into.
Are elastics used when the clear aligner fails to move the tooth or is it sometimes incorporated into the original treatment setup?
One must remember one of the basic tenets of clear aligner treatment: when a tooth is properly/fully encased in the plastic aligner material, it cannot be moved except by the forces built into the aligner.
Elastics are effectively used in conjunction with aligners in two scenarios:
- Class II elastics, Class III elastics, and vertical elastics can be used with aligners to effect dental arch (skeletal) movement, not individual tooth movement. This type of elastic application should be incorporated into the initial treatment plan designed by the doctor and can be included in "Additional instructions" when submitting a case.
- Elastics can be used to extrude individual teeth into occlusal gaps in the aligner caused by the teeth not moving as expected.
I have difficulty adhering buttons to crowns, any suggestions?
Assure PLUS All Surface Bonding Resin from Reliance Orthodontics is great for bonding to crowns. You may also want to consider using micro-abrasion to roughen the porcelain surface.
I have trouble with not being able to have elastic hooks or button cutouts in aligners. What do you recommend?
Since cutouts are not offered at this time, an alternate option is to create your own cutouts with a hole punch or coarse football diamond bur. If the patient declines this option, then you may want to explain the potential consequences of reducing the efficacy of the aligner treatment.
I have trouble getting the button to stay on the aligner.
Due to the flexibility of the aligner material, it can be difficult to keep buttons bonded to the aligner material. You can try micro-abrasion to roughen the aligner surface before bonding.
Can you develop a way to use elastics?
If the doctor desires to use Class II or Class III elastics as treatment auxiliaries, ClearCorrect recommends aligner treatment where the treating doctor uses elastics and buttons bonded to the teeth, since cutouts or notches in the aligner material are not offered at this time. This technique is more efficient, effective, and practical for the doctor.
Could you use ramps on upper anteriors to help open closed bites?
ClearCorrect does not build ramps into its aligners. There is no credible research validating the clinical effectiveness of built-in ramps. Incisor intrusion is a more effective and predictable technique for improving deep bites.
With ClearCorrect aligners, how extreme can you go in the overall treatment plan?
ClearCorrect is an advanced system of clear aligner therapy that uses the latest digital technology, design and clinical approaches. ClearCorrect aligners have been used to treat a wide range of types of malocclusion, ranging from simple cases to advanced extraction and surgical cases, alone and in conjunction with other techniques. Success will depend on the expertise of the doctor, the compliance of the patient, and biological factors.
A big thank you to all the providers who answered our survey!
Check out our Help Center for more helpful information on clear aligner treatment.
Until next time...