Written by Dr. Tanya Prasad, BDS, MDS (Ortho) | Medically Reviewed by Dr. Shaista Salam, BDS, Dr Seema Daradkeh, DDS, MFD/RCSI, MSc Public Health
Table of Contents
2. Diagnosis and assessment: criteria to select your cases
3. Clear Aligner treatment planning: goals & incognita
4. Patients education and communication: XX rules to achieve compliance
5. Case monitoring and complications management
6. Case completion and retention
Orthodontic treatment has evolved significantly over the years, with clear aligners emerging as a popular alternative to traditional braces. Clear aligners offer a discreet and comfortable solution for correcting dental misalignments. Currently, aligners are at the forefront future of orthodontics due to their undeniable advantages over fixed brackets such as aesthetics, comfort, enhanced oral hygiene, and dietary freedom. In this article, we will provide a concise overview of the steps involved in clear aligner treatment planning with the key steps being:
1. Initial consultation and diagnosis
2. Case selection
3. 3D Treatment planning
4. Patient education
5. Monitoring progress
Clear aligners are one of the most preferred orthodontic treatment modalities by patients. However, it is the job of a dental practitioner to select cases that are optimal for aligners and can bring satisfaction to their patients. Ideal cases that can be treated via aligners include mild crowding, spacing, and constricted arches. Malocclusions requiring intrusion of teeth, rotation correction, or deep bite correction warrant knowledge of aligner biomechanics and staging of movement to achieve predictable results with aligner therapy. A precise treatment plan can be formulated after the following evaluations(1).
A patient's medical and dental history is an important step for both the clinician and the patient. As aligners are contraindicated in certain cases, this evaluation makes the clinician aware of existing conditions that can affect the aligner treatment plan.
To ensure optimal patient satisfaction, it is essential to identify and manage realistic patient expectations. A dental practitioner is responsible for ensuring that a patient has a realistic understanding of what aligner treatment can and cannot accomplish. Clear communication and transparency throughout the treatme nt process are key
This integral step will include analysing the alignment of the teeth, assessing the relationship between the upper and lower jaws, and evaluating the overall facial profile. Moreover, analysing a patient's periodontal health and occlusion can help in identifying any functional issues that may need to be addressed during clear aligner therapy.
Intraoral scan allows a practitioner to visualise the patient's dentition in 3-D which helps in viewing the position of every individual tooth and its relation to other teeth. Along with that, X-rays provide valuable insights into the patient's dental and skeletal structures, allowing orthodontists to accurately evaluate the position of the teeth, the roots, and the overall bone health.
Digital smile design involves the use of advanced software to create a virtual representation of the desired final outcome, allowing orthodontists to communicate and visualise treatment goals with patients. The science of treatment stimulation helps in mapping out anticipated tooth movements throughout the treatment process to refine the treatment plan and ensure optimal results.
Selecting a reputable and reliable clear aligner system is crucial for successful treatment planning. Working with a trusted aligner system ensures access to high-quality materials, advanced technology, and ongoing professional support throughout the treatment process.
The first step in clear aligner treatment planning involves importing the patient’s details, case history and records (Intraoral scans, PVS impressions and orthodontic photos) obtained into the case management software. (4)
In this stage, doctors set the desired treatment goals and objectives. Goals may include aligning teeth, closing gaps, correcting rotations, or addressing bite irregularities.
Advanced digital software provided by aligner companies can precisely determine the timing and sequence of aligner changes to achieve the desired final result. Digital simulations allow orthodontists to visualise the predicted progress and make necessary adjustments to optimise tooth alignment and occlusion. (2)
In some cases, the use of attachments and additional techniques may be necessary to resolve more complex malocclusions. These attachments provide additional support for aligners, enabling controlled tooth rotations, extrusions, or intrusions. Orthodontists strategically place attachments based on the treatment plan to enhance the predictability and efficiency of the aligner therapy.
Orthodontists closely monitor the progress of the treatment and make necessary adjustments as needed. Refinements can include additional aligners or the use of supplemental techniques to ensure optimal outcomes and address any lingering concerns
Regular monitoring and follow-up appointments are essential to track the progress of the aligner treatment. Through periodic check-ups, adjustments can be made to the treatment plan, ensuring that the aligners are delivering the desired results.
Patient compliance is one of the cornerstones of Clear Aligner therapy. A practitioner needs to communicate with the patient and help them understand the treatment goals and how their compliance can affect these goals. There are some crucial points that a practitioner should address with their patients to help them better prepare themselves and remain committed to the treatment plan. (3)
Patients should understand the duration of clear aligner therapy can vary depending on the complexity of their malocclusion. By explaining the estimated timeline upfront, dentists can manage patient expectations and alleviate any concerns or frustrations that may arise.
Orthodontists can proactively prepare patients and enhance overall patient compliance by effectively educating patients about the potential challenges associated with speech adjustments and the minor discomfort that may arise during the initial days of wearing aligners. (6)
Patients must understand the importance of maintaining excellent oral hygiene practices throughout treatment. Practitioners can demonstrate the proper brushing, flossing, and rinsing techniques to prevent plaque buildup and maintain optimal oral health.
It is crucial to educate patients about their role in the treatment process and emphasise the importance of wearing aligners for the recommended duration. Patients should be made aware of the potential consequences of inconsistent or inadequate aligner wear
Some common issues faced during clear aligner therapy include initial mild discomfort, changes in speech, or slight soreness of the gums. By educating patients about these potential concerns, practitioners can provide necessary guidance and precautions to mitigate any discomfort.
Regular check-up appointments allow practitioners to assess treatment progress, monitor tooth movements, and address any emerging issues promptly.
Practitioners should assess the aligners' fit at each visit, ensuring that the fit is snug, and apply the necessary forces for desired tooth movements. In the event of any fit discrepancies, adjustments or refinements can be made to maintain treatment efficacy.
Addressing patient concerns and queries can help practitioners provide appropriate guidance and reassurance while enhancing treatment compliance and fostering a strong patient-doctor relationship.
Upon completion of the active aligner treatment, a patient is transitioned to the retention phase, preventing relapse while maintaining the newly aligned teeth. There are different options available for retainers, such as:
Patients should be instructed to wear retainers full-time initially and then gradually transition to nighttime wear over a specific period. Follow-up visits after the end of treatment ensure the stability of tooth movement and result in optimal patient satisfaction.
Clear aligner treatment planning is pivotal in achieving optimal outcomes for patients seeking orthodontic correction. By conducting a thorough evaluation, setting clear treatment goals, and utilising advanced digital tools, orthodontists can develop personalized treatment plans that address each patient's unique needs. As this innovative technology continues to evolve, orthodontists must embrace and adapt clear aligner treatment planning in their practices. By doing so, they can provide their patients with the benefits of this modern approach, ultimately transforming smiles and improving overall oral health.
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