When cases derail
If you are currently treating patients for orthodontic procedures, including using ClearCorrect, no doubt you’ve come across some troublesome cases that just don’t seem to track accordingly.
This can be frustrating and time consuming, not only for the clinician but also the patient.
Getting the patient back to take new scans or impressions is everyone’s least favourite thing to do, so I’ll cover some reasons why these cases may derail, and the steps needed to get them back on track.
Aligners with incisal gaps Let’s start with one of the most common struggles you might encounter. The patient arrives for their appointment, you attempt to place the aligner and you find it does not seat correctly or appears to be ill fitting. You’ll notice an incisal space between the tooth and the aligner.
The most common cause for this is non-compliance (where the patient has not worn the aligner for the necessary amount of time as instructed) or there has been insufficient pressure or space to allow the teeth to move into the desired position.
When the teeth do not move accordingly, it becomes a domino effect. The next aligner will be ill fitting, and so forth until a revision is required to get the treatment back on track.
You’ll need to reiterate to the patient the importance of wearing the aligners for the required 22 hours per day, and if possible, consider backtracking to the previous aligner.
Sometimes wearing the previous aligner for an extra couple of weeks can help the teeth complete the prescribed movement.
Consider also increasing the wear schedule of each aligner – sometimes an extra week of wearing each step is what the patient needs to stay on track.
Tight contacts exist when there is compression between two teeth. You may find that the prescribed amount of IPR in the treatment setup is sufficient, however there may be added pressure from other teeth which close the space created when performing IPR.
Here’s an example:
0.3mm of IPR is requested between teeth 14 & 15, but there is compression (hidden pressure) between 15 &16. When space was created with 0.3mm of IPR, the pressure was released between 15 & 16 now creating normal contact levels since tooth number 15 has been given space to move over.
If this occurs, you do not always need to request a revision. This can be time consuming, and frustrating for both parties. Consider hand stripping extra space between tight contacts (about 0.1 mm) to allow the teeth room to move, or if there is some misalignment (such as crowding or rotations) it can also be a good idea to perform a little extra IPR in these instances (again around 0.1 mm is sufficient). Then simply wear the aligner for an extra week or so to allow the pressure to help move the teeth, now that there is more space.
Cases can derail when there is not enough pressure applied to the teeth to initiate movement. This will occur due to patient non-compliance, some clinical factors such as short crowns, lateral teeth can be a nuisance and certain tooth movements , including rotations, intrusion and extrusions can hold back the pressure.
The solutions can be general or more specific to the problem. For example, requesting engagers in your treatment setup or creating your own retention dimples can help increase pressure. Using auxiliaries such as buttons and elastics can help with extra pressure in movements such as rotations and extrusions. You can check out our range of orthodontic accessories here.
Overcorrection can be requested in the treatment setup to add extra pressure in the last few aligners to help the teeth move into their final position, and a digital power chain can be requested to close any residual spacing.
General solutions include backtracking, increasing the wear schedule of the aligners and ensuring the patient is compliant.
Remember to keep accurate records so you can check the progress of the case, including photos, the current step being worn and where the issue may have started.
As the treating clinician, ultimately the responsibility is in your hands, and at some point, you may need to consider a revision if you have tried the tips and tricks mentioned but the case is still not tracking.
The last thing we all want is an unhappy patient, therefore setting realistic expectations of the treatment and what to expect during clear aligner therapy is important.
If you have any questions about your case, get in touch with your account rep, check our help centre, or give us a call at 1300 029 383.