Personalised Learning

Choosing your first patient

Congratulations, you’ve taken the first step in providing a new treatment for your patients! We understand that providing new treatments can be exciting and challenging no matter how experienced you are as a dentist. That’s why we are here- we want to help you feel confident from the outset, to provide support along the way, and to cheer you on as you master the art (and science) of clear aligner therapy.

As part of taking the first plunge, you may be wondering; how do you pick the “right” first case? We hope this topic helps provide some general guidelines and pointers that may help you with case selection.

The demand for clear aligners is increasing

The general public awareness and knowledge of clear aligners has increased significantly in the last few years. This is great because it gives you a foundation to work from but it also means that more and more people will come into your office wanting clear aligners. However, not everyone will be a candidate for them!

Patient Selection


For your first couple of cases, our advice is to be strict with yourself! 

Start with a patient that has a more relaxed  temperament- for example, one who won’t mind you taking your time or having to retake an intraoral scan if needed. 

Most dentists will choose a patient they’ve known for a while, a nurse, a friend, a partner or anyone they feel comfortable with. Remember, you will not only learn along the way with your first case but you will also see this patient every 4-8 weeks during treatment. Not to mention, you’ll complete any cosmetic work and supervise retention for a long time afterwards!


Outside of ensuring the patient is someone you feel comfortable with, ensuring that the patient's expectations are aligned with yours, as the provider, is crucial. High or even unrealistic expectations can make a case quickly go from simple to complex. Here are a few potential expectations to look out for:

✔ Wanting midlines to match up 100% perfectly

✔ Significant changes to current smile dimensions rather than alignment only

✔ Wanting things to be done in a short time frame despite complexity

✔ Multiple rounds of previous orthodontic or cosmetic work but still not up to the patient’s standards


Keep in mind that few cases are ‘simple’ in orthodontics, in fact, many of the cases that appear to be simple at first glance may have some underlying complexities. With that being said, there are aspects that can make a case more difficult; we call these “hallmarks” of a complex case and we’d suggest you avoid these for your first case:

✔ Severe crowding (>8mm)

✔ Multiple significantly rotated teeth (>30 degrees)

✔ Severe underbites or overbites

✔ Significantly shifted midlines (that the patient is keen to correct)

✔ Large spaces to close


No matter how well you mitigate the complexity of a case, you will not achieve the desired outcome if patient compliance is not there! Understanding your patient’s motivations and knowing their routine/habits can:

✔ Help predict if aligners will be worn for the recommended amount of time

✔ Likelihood of showing up for routine appointments

Lastly, we know we don’t need to tell you this as you’ve got it covered, but outstanding dental issues are a non-starter for orthodontics. It’s vital to stabilise first!

What if I'm not sure?

If you aren’t sure about the complexity of a case that is alright, your specialist orthodontist and the 32Co team helping you on the case will provide guidance, and warn you off any cases which could pose potential problems.

Key takeaway

Remember that the orthodontic complexity assessment encompases many patient factors; don’t underestimate these and be prepared to say no to patients! 

Discussing clear aligners with patients? Click below for a quick guide

Quick Guide

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