CLINICAL GUIDE
7 Top Tips for Aligner Success
The seven things that most influence a successful Active Aligners outcome, from planner instructions and case review through fitment, IPR, attachments, monitoring and retention.
SEVEN TIPS
Detailed instructions to treatment planners
Planners design for the best possible outcome using orthodontic principles and our movement protocols, but your input matters. Share your instructions, your concerns and what the patient expects, so the plan is designed with the desired outcome in mind and you avoid redesign delays. Include anything that may hinder tooth movement (e.g. an implant or crown). For missing teeth where you need to create space for an implant or future restoration, either (1) scan a tooth into that space as a temporary placeholder, or (2) submit for a Smile Design (extra cost) to add the tooth, we print the finished design’s model and use it for treatment planning. No dental work should be done during treatment, as it will stop the aligners fitting correctly.
Case review, own the case
Always review the case in detail. Look at the movements you’ll monitor throughout treatment, and the outcome, make sure the patient understands the improvements and the potential result (you can send them the treatment-plan link via Actions). Treatment decisions and case diagnosis are entirely the responsibility of the prescribing doctor.
Correct fitment
From stage 1, make sure aligners seat correctly, no gaps, especially on the occlusal edge. Show the patient what a good fit looks like so they can monitor it at every change. The fit must be snug with all attachments engaged. If the fit isn’t right, don’t proceed, analyse why (attachments, compliance, a stubborn tooth). For example, a patient on stage 12 whose movement only matches stage 5 means fitment failed from stage 6 and should have been caught then. Use chewies (a spongy Styrene Copolymer): position between the teeth and bite from one side of the mouth to the other for 15 seconds per side, daily, especially when moving to the next stage.
Sufficient IPR
Always use an IPR gauge to confirm the correct amount of IPR has been achieved, and check the treatment summary for which stages require it (IPR may be needed at multiple stages). Insufficient IPR is one of the biggest causes of mis-tracking. See our Guide to IPR.
Correct application of attachments
Keep attachments clean, without too much excess material, and make sure the template is seated correctly when applying them, this affects all future aligners. If attachments don’t engage properly, the aligner puts pressure in the wrong direction and causes unplanned movement. If an attachment falls off during treatment and the stage is more than 50% complete, use that stage as a template and move to the next; otherwise use the previous stage. See our Guide to Attachments.
Monitoring and patient compliance
Monitor patients sufficiently, especially difficult cases, checking against the platform stages. Pay attention to areas needing IPR, since contacts can block movement (additional IPR frees them). For stubborn teeth, consider wearing a stage an extra week. See the patient at least every 3 stages; the number of aligners given is at the dentist’s discretion. Compliance is key, without correct wear, each stage fits worse until the case won’t track. The an aligner tracking app app helps patients remember to wear their trays. To keep patients on track: Educate (explain how aligners work), Involve (record-keeping and goal-setting), Communicate (be honest that aligners are uncomfortable at each change), Document (wear, cleanliness, missed appointments, seating, attachments) and Adjust (longer wear, backtrack to a fitting aligner, additional IPR, or re-attach using the previous stage as a template).
Sufficient retention
Patients need to know that not wearing retainers for even a couple of days can have an immediate impact. We recommend full-time retention for 3 months or more, then indefinitely at night. Fixed retainers help patients who won’t wear removable retainers at night and can be the preferred option to prevent relapse. If a case is monitored and tracking correctly, there should be no need for a refinement. Lab note: export retainers if you want retainers without attachments, we manufacture the last stage in retainer material plus a set of retainers (this is the free set received with a case; anything requested after that is a new order). Fixed wire retainers are custom-contoured to each patient’s printed arch via 3D technology (standard 0.7mm wire, 0.5mm on request), include a placement stent, require upper and lower scans, and should be used only after the 3-month retention period.