Clear aligner treatment has become more widely known within the last decade thanks to media coverage. Clear aligners have often been marketed as a fast, aesthetic, and convenient alternative to metal braces; no wonder they have grown in popularity. However, many of the nuances of clear aligner treatment have taken a back seat to the hype. Here, by highlighting some common issues that patients deserve to be made aware of, we hope to help you and your patients navigate the uncertainty of embarking upon a course of aligner treatment together.
Often times patients are most concerned with the teeth “they can see”, therefore a common request is to only treat or straighten the upper arch. It’s important to note that treatment of a single arch might introduce arch coordination problems and reduce predictability of a given outcome. While some single arch corrections can be made without much compromise, usually by explaining the why to patients (ie. the importance of a coordinated bite) they will be keen to treat both upper and lower arches.
Once a patient has decided to go ahead they will be anxious to get cracking. Their enthusiasm is great and definitely can improve treatment compliance but you’ll want to make sure there is not any work outstanding to get their teeth and gums healthy.
While you may have said it multiple times previously, this is a good time to reiterate the full process to the patient! Focusing on things such as turnaround time, attachments/IPR/elastics and refinements.
Start by covering how the appointments are set up and what will occur at each appointment. For example: “we must take an impression or scan of your teeth so the aligners can be fabricated to fit based on your specific outcome. Your next appointment will be records so we can get those and send them off. From there, I will work up your case with the help of a specialist and discuss with you the expected outcome. If we are both in agreement with the given plan, then the aligners will be manufactured. This process can take a few weeks but when you get your aligners we will also be bonding the tooth colored bumps, and if needed any buttons for elastics.”
With any tooth movement, inflammation arises which causes the soreness, especially for the first 8 hours. It would be just the same with traditional braces, if not worse due to an added factor of soft tissue trauma.
If the soreness is a little too much for them, you can advise patients to use whatever they would normally take for a headache to ease some of the symptoms.
We understand that it can take getting used to new habits when it comes to eating and drinking with aligners. It will soon become second nature to patients! We advise you to inform patients that aligners can stain and start to smell unpleasant after many days of use so it will be important to not only ensure they’re brushing their teeth but that they’re also cleaning their aligners on a daily basis.
Attachments are ideally placed and remain throughout the full treatment. They are exposed to a great deal of force and food/drinks that are consumed so they do sometimes come off or can be prone to staining. Ask your patients to monitor them closely and let you know if they become damaged. Let them know in advance that if one debonds then you will determine if it will need to be re-added or not because sometimes the necessary movement has taken place and the attachment will not have any negative side effects if left off. This will help down the road from patients feeling as though they are getting short-changed by not having an attachment added back on.
Patients will lose their aligners and aligners can also sometimes break. Your patient should not be surprised to find out that replacements cost money and might cause delays. It helps to let them know this upfront and to train your front of house staff so that there is no uncertainty around finances and logistics for replacements.
The first step when a patient mentions gaps is to determine if it’s truly a space between teeth or if the patient is referring to a black triangle. Usually, taking a piece of floss between the contacts is the best determinant and can help explain to patients the difference. If a distinct floss “click” is felt then you and the patient know the teeth are touching; however, due to its shape or gingival support there is a black triangle or vice versa. It’s important to inform patients of black triangles from the start of treatment so they are not surprised by it later.
Refinements are not uncommon and the need for a course correction can be spotted early with diligent monitoring. If patients are shooting for ideal then we typically mention that the first set will do a lot of the heavy lifting but will most likely need some fine-tuning.
Retainers should be worn for as long as the patient wants to keep their teeth in the final position, this will avoid them reverting back to their original positions and avoids age-related tooth movements. Mentioning to patients while we wish there was something to hold teeth permanently, the same reason we can move teeth is the same reason teeth can shift again. Retainer wear should be “nighttime for a lifetime.”
Every patient journey is different and will throw up new and unique challenges for individuals. Helping people to solve these problems and progress to a successful outcome is a thoroughly fulfilling process to be a part of.
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