CASE WORKFLOW
Patient Monitoring Guidelines
How to monitor treatment, keep patients on track, handle mis-tracking and refinements, and the top causes of refinements to avoid.
MONITORING PLAYBOOK
Monitoring checklist at appointments
Every review appointment follows the same short checklist. Work through it in order so nothing gets missed between one set of aligners and the next.
- Check that the aligners fit and are seating fully across the entire arch
- Ensure all attachments are still in place
- Check all contact points, pay special attention to areas where IPR is needed, as movement can be blocked by contacts (additional IPR can free them)
- Proceed with further IPR if required or indicated in the plan
- Deliver the next set of aligners
- Schedule follow-up appointments
Monitoring beyond the chair
Modern communication tools (WhatsApp, email, video, Google Forms) let dentists and the lab monitor progress closely, comparing photos at each stage against the 3D predicted plan, for near real-time tracking without wasted appointments. An aligner tracking app is a useful way to remind patients to wear their aligners and to book follow-up appointments (important when IPR is indicated at a later stage).
TROUBLESHOOTING
If an aligner is not seating or tracking
When a stage stops tracking, work back through the likely causes before you change the plan. Most of the time the answer is compliance, IPR timing, or seating, not the design.
- When did you last see the patient, and when was it last seating correctly?
- Was ample IPR done, at the correct stage?
- Is the patient being compliant?
- Request an overlay of the original scan to the current position to see where tracking stopped or which tooth is the problem area
- Did you explain what seating/engagement looks like and what to watch for (space between aligners and teeth, attachments not engaged or falling off) and how to rectify it?
Lost, broken or detached
- Lost aligner, in week 1 of a stage, move back to the previous stage while a replacement is ordered; in week 2, move on to the next stage. (Replacements ship within ~3 business days, at an extra cost.)
- Broken aligner, send us a photo (or the aligner) so we can determine the cause and assist with a solution
- Attachment fallen off, use the current stage as a template to re-attach
Please note: no changes or dental work should be done during treatment, as this will cause the aligners to no longer fit correctly and therefore not be effective.
MIS-TRACKING
Mis-tracking and refinements
Minor mis-tracking: at the end of treatment a refinement (3 to 4 aligner stages) can be done at a reduced cost. Contact the lab to see if the patient qualifies for an in-house refinement.
Large-degree mis-tracking during treatment: hold the patient in the best-fitting stage; take new impressions/scans and create a new treatment plan at a reduced cost; capture new intra- and extra-oral photos; you’ll receive a new refinement plan to review and approve, and new aligners are ordered. Large-degree mis-tracking usually results from non-compliance with the recommended 22 hours/day wear time.
A refinement corrects what did not track in the original case, and should only be created once the patient has commenced the original treatment. A refinement of an anterior case cannot request full-arch treatment planning.
The top 4 causes of refinements
- Non-compliance, screen patients, educate, and set expectations; patients who don’t wear aligners as directed won’t reach their outcomes
- Aligners not seating correctly, aligners must fit snugly to apply pressure; stress the importance of chewies at the start of each stage and every re-insertion; ensure attachments engage at every stage
- Not enough IPR, always use an IPR gauge for 100% accuracy (strips are only an indication); many plans require IPR at later stages, so check the plan carefully
- Case not tracking / not monitored, book a follow-up one month after starting, then every 6 weeks / 3 aligners; review the patient’s 3D plan at each visit to show progress
COMPLIANCE
Keeping patients on track
Compliance is the single biggest predictor of a clean case. Five habits, set early, keep most patients tracking to plan.
- Educate, at the initial consultation, explain how Active Aligners work (there’s a summary in the patient instruction booklet, plus our How Active Aligners Work video)
- Involve, involve the patient in record-keeping, planning and goal-setting to keep them committed and compliant
- Communicate, be honest about the process; aligners are uncomfortable at the start of each change; listen to concerns and encourage by showing the expected outcome
- Document, watch whether they’re wearing aligners, whether the aligners are too “clean”, missed appointments, correct seating, and attachments present and engaging
- Adjust, they may need to wear aligners longer, backtrack to an aligner that fits, do additional IPR, or re-attach a lost attachment using the current stage as a template
Tip: add an extra day or two to the current aligner if wear time has been less than ideal. Patient compliance is key.
Tips for treating teens
Teens need a little extra structure. For the full playbook, see treating teens, tips and tricks.
- Check the amount and stage of IPR required; use an IPR gauge
- Manage expectations with both parents and teen, commitment and consistent wear are the best predictors of success; some discomfort during initial changes (much less than traditional braces); retention is for life
- Pay attention to the placement of composite attachments
- Retention is non-negotiable
- Clear instructions to the treatment planners, and case review, are extremely important
- To help early compliance, consider asking treatment planning to add engagers/attachments at stage 3 (easier to remove and replace before then)
- Emphasise using chewies so the aligners seat properly
RELATED RESOURCES
Related resources
The guides that pair with monitoring, refinements, IPR, attachments and treating teens, all in the Doctor’s Library.
Case selection and movement protocols
What tracks predictably, what needs staging, and how refinements fit into the plan.
Guide to IPR
When and how much IPR to do, and why timing it correctly keeps a case tracking.
Guide to attachments
Placement, engagement and re-attaching, so aligners seat and grip at every stage.
Keep every case tracking to plan
Become an Active Aligners provider, or explore the complete monitoring toolkit in the Doctor’s Library.