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Recode Aligners product manager, Laura Palacios, gives you some tips for highly predictable results in invisible aligner treatments.
Although there is some scientific literature on the predictability and efficacy of movements in orthodontic treatments with aligners, it is equally or even more important to take some tips for good practice into account, not only during the treatment but before it begins too, to be able to properly monitor your cases at the clinic.
This post is aimed at all dental professionals who accompany the patient at one stage or another of the treatment. Movements in orthodontic treatments with aligners.
Communication and objectives
It is vitally important to ask the patient what their objectives are. Once the orofacial examination has been carried out, the possibilities or difficulties of the case must be carefully explained, how long the treatment could take, if auxiliary components or techniques will be necessary, etc.
This communication with the patient will reveal their degree of commitment and help establish realistic treatment goals. movements in orthodontic treatments with aligners.
It is essential to establish the objectives of the treatment. What is going to be treated or what is not and how, and if the treatment with aligners will be in addition to other treatments (aesthetic veneers, placing implants, etc.).
Pretreatment
Once the intraoral examination has been carried out and the treatment accepted by the patient, the first step is an oral hygiene procedure. This removes the plaque adhered to the tooth enamel that can block certain interdental areas, making the impressions taken of the patient much more accurate.
Containment aligner
Once the cleaning has been carried out and the impressions taken (conventional or intraoral scanning), it is important that the patient is able to maintain this level of hygiene until the orthodontic treatment with aligners begins. Bacterial plaque can cause interference that prevents the aligner being correctly seated. Thus, using a single aligner after cleaning, to ensure the teeth remain immobile during these weeks, may be the key to a good start to the treatment. In addition, the patient gets used to using aligners with a more gradual adaptation, avoiding the stress of the first days.
Inform the patient about the first aligner beforehand
On the first day the patient returns to start their invisible orthodontics treatment, it is important to explain in detail the oral hygiene routine they must use from now on. Using a dental pick and floss ensure good maintenance.
A good control protocol may be to use dental floss on the patient each time they come to the clinic, to ensure there is no interference. This simple procedure can avoid an IPR (Interproximal Reduction) of 0.1mm in some areas. It is also very important to remind the patient to keep the previous aligner when they change to the next and to bring it to each appointment. We’ll explain why further on!
The importance of placing the attachments
As a control, placing the attachments properly is just as important as flossing. There are many protocols available today, so this post is not going to go into them. If your clinic has a protocol that works, why change it?
The important part of this step, which might not be taken into account, is to remove any excess material. Reworking the geometry and removing any excess spread over the tooth will make it fit into the aligner perfectly and fulfil its purpose. Otherwise, if the excess is not removed, aside from being ideal for plaque growth, it creates a micro gap that will lead to accumulated errors throughout the treatment and in the end some teeth might not follow the planned movements aligners.
Device for biting and securing the aligner in place
Although we know that biting the aligners together to get them in place is not indicated, that manual pressure for insertion is sufficient, it might not be completely effective. There is a device called a “chewie” that is perfect for ensuring the patient places their aligners properly. It is a silicone tube, approximately 3cm long, with an internal channel, that can be found at any dental retailer. The patient should bite it when they put the aligner in, and several times throughout the day if they wish. It might seem silly, but it’s really very effective!
Revision of aligner fit the throughout the whole treatment
It is essential to monitor the treatment with our patient, checking the aligners are still seated correctly, and if this is not the case, a simple trick can help you see quickly whether the tooth is following the aligner in the relevant stage. With a graphite pencil, paint the flat face of the attachment and place the aligner, this will show whether there is displacement in the sequence or not. If there is displacement, this can be verified with the previous aligner. Sometimes there is no need to worry, it may be that that tooth is a little harder to move, but that does not mean you need to request a refinement. Try the previous sequence and, if it fits better, recommend the patient wears it for a few more days and check at the next appointment if you can continue the treatment as usual.
It is important that the patient wears the aligners for the hours stipulated, a minimum of 22 hours a day, and that the aligners are changed every 10 days, unless the specialist indicates otherwise.
Attachment
What happens if an attachment comes off? You should always save the attachment positioning template, thus if one comes off you can position it again easily. As the teeth have already moved, simply trim the aligner with the fragment of the tooth with the attachment and position it again.
Follow the treatment instructions and don’t skip any IPR!
Keep the patient’s information to hand to proceed to each stage with the instruction provided, as, otherwise, a movement might be blocked.
On some occasions the CAD Designer may associate an IPR of 0.1mm to certain movements, such as collapse in the anteroinferior sector, which is not always necessary. Therefore, it is important to check the IPR and evaluate how and when they are really necessary.
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Don’t forget that communication with the CAD Designer is essential, as they are going to convert everything transferred by the clinic into the treatment, so the more accurate the information, the more precise the proposal.
Laura Palacios of Avinent Orthodontics
It is also important to validate all aspects of the case summary: feasibility of the movements, IPR amount, number of aligners, amount of movement per stage, etc.
Remember that at Avinent there is a team of people who can help, through the platform or by telephone, to resolve any doubts.
For now, we’ll leave you with this tutorial to start to create your invisible aligner cases in the Professional Portal of Recode Aligners.
Keep an eye out for the next articles, which will be on very interesting topics, such as refinements, revising treatment proposals, communication with the CAD Designer and more!