CLINICAL FEATURE
Troubleshooting common problems in case finishing for clear aligner treatment Specialist orthodontist Dr Kenneth Lew shares methods and workflows to troubleshoot six common problems faced in finishing for clear aligner treatment.
INTRODUCTION Since 2010, the clear aligner industry has grown dramatically, helping many patients who want better smiles without the use of fixed braces. With the rapid growth of clear aligner brands, dentists have faced several challenges in optimal case finishing for clear aligner treatment. To add to the complexity of managing these clear aligner cases, two major challenges are present: 1. In the clinicians’ ability to interpret 3D-digital treatment simulations as to how predictable the plan would be and if needed, fine tuning these plans to a nanometer of optimality. 2. The challenge of patient motivation and co- operation in the use of aligner appliances for 20-22 hrs per day to prevent off-tracking. TROUBLESHOOTING AT END OF TREATMENT Crowding/rotations not fully resolving at end of treatment At the patient review appointment, when teeth that are supposed to align according to the treatment simulation but do not, first check the clinical situation intraorally. 1. Check the interproximal contact points with floss. Run interproximal diamond strips to clear these tight contacts should the contact points be tight resulting in hindrance to the alignment of teeth.
2. Using the dimple pliers, appropriate forces could be applied on the last aligners for teeth that require additional force to effect the desired orthodontic tooth movements such as rotations, palatal or labial movements. The dimple plier creates a tiny dimple- sized convexity in the aligners (what are commonly called as “divots”, or “pressure areas”) to move for example either the buccal surface lingually or the lingual surface buccally. If a divot force is put in opposite directions on the mesial of the labial surface tooth and distal of the lingual of the tooth with the dimple plier, the teeth can be rotated. 3. If there is a small space of 0.1-0.2mm between teeth, a dimple plier may apply a labial force to close the space. Persistent diastema opening because of traumatic occlusion from opposing arch In some cases, a patient might be wearing the last aligner/retainer on part time basis only (night time sleeping hours), and a small diastema opens between the upper incisors at the end of the day. This is likely due to a heavy inter-occlusal contact from the opposing lower incisors. In such cases, it would be useful to test for fremitus/premature contact by placing a finger on the labial surface of the teeth in question. Check with articulating paper for the exact area of premature contact. After ascertaining the tooth/area causing the high contact, equilibrate
A dimple plier is a useful tool to master for minute misalignment of teeth at the end of clear aligner treatments (Image: Precision Dental Instruments)
the palatal surfaces of the upper incisors with a high speed pear-shaped bur to relieve the heavy anterior occlusal contacts. Off-tracking Minor off-tracking: Off-tracking < 1mm of space between the aligner and occlusal/ incisal surface of tooth/teeth is considered minor. Use a chewie and bite 5mins three times a day on the tooth/teeth in question without changing to a new aligner. This
35 DENTAL ASIA SEPTEMBER / OCTOBER 2024
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