Submitting your first case?
Some things to consider for the new provider
Submitting my first case
Patient assessment is key
Will this patient be a good candidate for 3Dalign?
One of the best ways to determine if your patient is a candidate for clear aligners is by determining if they will be compliant or not. If you suspect they will not be compliant, meaning if your patient cannot agree to wearing aligners for 22-hours a day, they are not likely a good candidate for clear aligner treatment and it’s more than likely that you and your patient will not get the desired results.
As a new provider, some examples of good initial candidates for clear aligner treatment, in addition to committing to full compliance and wear, might have:
- Minor anterior spaces or crowding.
- Ortho relapses.
- Single arch treatment with minor goals.
What type of movement can I achieve
Due to variations between teeth, some are more amenable to certain types of orthodontic tooth movements with clear aligners than others. Here are some rough guidelines to help you choose cases and calibrate expectations.
Basic movements
Clear aligners are particularly-well suited for facial/lingual movements. They excel when there's a broad surface to apply force to, and adjacent retentive surfaces to anchor against.
Moderate movements
- Distal/mesial movements - if there is inadequate tooth contact with the aligner with the portion of the clinical crown to "push" the tooth in the desired direction, consider adding an attachments for additional surface area.
- Most rotations/rotations of lower premolars - ensure there is adequate space to rotate the tooth and consider the position of the tooth root as it is easier to rotate a tooth that is normally inclined. For example, a tooth that is mesially tipped should be up righted first before attempts to correct its rotation. Conically-shaped teeth, such as mandibular premolars, offer little natural morphology for an aligner to "grip" onto. These teeth commonly require attachments to provide for added morphology.
- Torquing - evaluate the crown morphology, particularly length of the clinical crowns as these are more easily torqued. Short clinical crowns and lack of defined crown morphology (e.g. bulbous shaped crowns) may be assisted with attachments.
Recording taking and consent
What records do I need to provide?
Accurate upper and lower impressions and a bite
- Digital scans preferred - accepted from all major systems. Please feel to contact us to confirm this.
- PVS or alginate impressions of high quality including all of dentition and margins. If teeth are missing from the impression these may be free to over-erupt or drift
- Bite registration in ICP
Photographs are optional but welcomed. These may be especially useful in planning cases where the midline is not coincident or the maxillary plane is not parallel and needing adjustment.
Completed prescription form on our profoma - describing the general aims of treatment, tooth movements required, IPR, requirements regarding overjet, overbite, attachments and any other information you feel relevant.
Patient consent
We provide a basic patient consent proforma which may be modified to suit a particular patient. Please ensure verbal and written consent is gained before any treatment is undertaken.
We recommend an OPT X-ray or full mouth PAs as well as a full dental examination prior to treatment.
Receiving your treatment plan
A 3d rendered treatment plan in video form will be provided along with a PDF file containing all necessary clinical information based on your initial prescription. Please take some time to look this over and ensure it meets the needs of both you and your patient.
At this point you may approve manufacture of the first aligner or request changes to the treatment plan, at which point the above is repeated. You may opt to receive a 3d printed study model of the final aligner stage at this point to aid with patient consent and treatment uptake.
Fitting your aligners
What should a proper fitting aligner look like?
A proper fitting first aligner should cover and fit snugly over all the teeth. It will feel tight at first. If there are any large undercuts then there will be a snap fit as the aligner attachments.
The aligner will usually cover the gingiva by around 2mm. All aligners will be trimmed differently depending on the patients tissue depth and dentition. The incisal edge of the teeth should fit flush with the aligner without any large gaps. If extrusions are planned and you have fitted attachments then there may be a slight gap.
The aligner should fit over the distal surface of the rearmost molars. There may be sometimes be some bounce in the fit stage but this will clear as the treatment progresses. Ensure that all prescribed IPR is completed as not doing this will prevent the teeth from moving and will stall treatment.
Please advise us if the first aligner fit is satisfactory and we will provide the first block of aligners as soon as possible.
What if fit is unsatisfactory?
Please see our troubleshooting section.
What do I do at the end of the first block of aligners?
When you come to the end of the first block of aligners you will need to asses the fit and progress of the treatment. If the patient is on track and you feel confident that tooth movement has occurred as planned then inform the 3Dalign team and they will send you the next block of treatment for immediate fit.
If you have concerns regarding tracking please take the time to assess why and if any of these issues can be resolved chairside. The most common issue is lack of compliance or teeth needing more time to track. If so continued aligner wear is recommended along with patient education. If necessary new records can be taken at this stage and treatment re-planned. These regular checks can help reduce wasted clinical time and get treatment get back on course.