Clear Aligner Work flow

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    Freedom Dental

    Visit One

    Freedom Dental

    The most important clinical visit in the aligner journey for the patient is the initial aligner insert appointment. This is the appointment that the patient after consenting to the aligner treatment plan actually needs to wear them. In this appointment the role of the clinician (dentist, therapists, hygienists) is to motivate and educate the patient.
    The misconception here is that it is only about how to wear and remove the aligners.
    However the key to success is to ensure the patient is overseeing and able to monitor optimal fit of the aligner.
    They need to be educated and motivated the patient to
    1 use the chewies or aligner seating devices ( chewies, cotton rolls, V -pro, accelerate devices ect…..) and to self evaluate when an aligner is not fully seated.
    2 use floss to ensure teeth are not binding that will result in aligners not being able to be fully seated
    3 attachments are fully engaging and are not detaching
    4 and if the time to change the aligner may be premature. (i.e the alinger still feels tight and not passive prior to moving onto the next alinger)

    Freedom Dental

    On going visits

    Once the expectation has been established it is the main focus for the clinician to ensure the patient stays motivated and dilligent when wearing aligners.
    During these appointments the clinician should start to:
    1 Ask the patient how they are going? and when are they NOT wearing the aligners.
    This tactic usually creates a more honest answer.
    An obvious concern occurs when a patient arrives without the aligners in their mouth for the appointment.
    Treatment should be paused and address the concern of the patient’s commitment at this point.
    2 Always have the software open and accessible to review.
    The importance of this is two fold. It reassures the patient that the treatment early on is working as they fear it is not working. It also assists the clinician to review teeth in the amber or red zone that may need further monitoring and confirm attachments are ok and wen to do IPR.
    3 Always check which aligner the patient is actually wearing by checking the number, how long the current aligner has been work and whether changes have been done as per prescription weekly or fortnightly.
    Ask the patient how it feels at the end of the cycle does the aligner feel loose? was there too much pressure when change over ….all this information provides clues on the how well the patient is going and how well the biology is tracking?
    4 Each visit clinician should also check contacts with floss to ensure not binding and use light ipr strip to open contacts in areas of moderate to severe crowding.
    5 Remember keep it possible we as clinicians are the PT of the oral cavity for our patients!!

    Freedom Dental

    Finishing visits
    As the patient is coming to end of their aligner treatment it is important to shift the attention to retention options and aesthetic finishing option.
    1 Aesthetic finishing options
    – use 3d ortho software to show patient shape of teeth and malaligned incisal edges, uneven embrasures, gummy smile ect.
    –educate and ask question as to whether the patient is ware or concern and what option there are to assist
    -discucss whitening options, composite augmentation options, enamel plasty options, botox, dermalfils, gum lifts,ect….
    2 retention program
    Review need for fixed wire versus clear retainers or both.

    Neha Singh

    How do we address patient concerns about black triangles being a possible side effect?

    Freedom Dental

    I would of course advise the patient in advance of the possibility black triangles during software viewing appointment. This would identify main areas that the patient would be concerned about and would most likely get address post .

    At this stage I would advise of options of leaving it as is vs IPR and space closure vs vs direct bonding/veneers vs injectable dermal fillers.


    Freedom Dental

    Also use the software to demonstrate possible risk especially when there are anatomically triangular lower anterior teeth and triangular upper lateral incisors

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