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Things not going according to plan? Check here to see if there is a simple solution.

The next aligner has an incisal gap

An incisal gap is when there is a space between the incisal edge of the tooth and the aligner. Incisal gaps are usually the first sign of a case going off track.

Incisal gaps can be caused by any of the following:

- The Patient is non-compliant and has not followed the recommended wear schedule of at least 22 hours per day.

- The patient is not getting the needed tooth movements with their current wear schedule - not enough time has passed for adequate tooth movement.

- Tooth movements have not occurred due to insufficient pressure or lack of space (rotations, extrusions, intrusions, torquing, tipping).

- The attachments are not fitting in the aligner


Try the following actions first:​

- Check for short clinical crowns. If your patient has them, follow the instructions for resolving this issue.

- Try keeping the previous aligner in for another week. Wearing the previous aligner longer will help the teeth complete the needed movements scheduled for that stage.

- Check the previous aligner and make sure it was fully seated and should be somewhat loose. This implies the fit is passive at this point and ready for further movement. If the previous aligner does not fully seat, have patient wear it for an additional week.

- If the previous aligner seats well, re-insert the original aligner and send the patient home for a week or until the aligner is seating.           

- If the gap persists, review your treatment plan showing which teeth are moving in each step. Some crowded arches contain tight contacts - which prevent teeth from moving. You may need to perform some additional IPR to ensure that the contacts are kept free.

- Has all the needed IPR been done? It needs to be completed before the relevant prescribed aligner stage.

The next aligner wont fit and is rocking.

Compliance is the main reason that clear orthodontic treatments do not track or are delayed. Ensuring 22 hours a day of wear time is agreed to and adhered to throughout is paramount. Without this tooth movement efficacy is compromised or even impossible. Every moment that aligners are not worn, teeth will be relapsing back to their initial position. While we respect the need for patients to eat and clean their mouth and appliances, this is an issue of communication and consent at the outset of treatment. Withouot adequate wear time treatment times can increase significantly, incur laboratory costs and give inadequate end results.

None compliance can be inadvertant or deliberat and identifying and managing this at an early stage is highly important. As such we recommend regular review visits and we have implemented checks at certain stages of treatment to ensure teeth are tracking.

We recommend and provide an aligner wear agreement and continual reminders to patients regarding compliance. This applies well into the retention period and we are firm believers in retention for life.

The treatment has stalled after doing well initially.

When a case is planned our team, space creation is often paramount. This can be done with extraction, arch expansion, proclination or IPR, or a combination of all, depending on how much space is required and where. However, despite precise and accurate planning, there can still occasionally be a lack of space, and as such, tracking may be compromised.

It is important to keep track of the interproximal spaces at every review appointment. This can be measured or simply assessed by passing something between the contact. We usually recommend that contacts are kept clear during alignment and certain spots will be highlighted on your initial treatment plan to monitor carefully. An IPR strip or reciprocating disc can be used to gently free a contact if it is binding and preventing movement. Failure to monitor this could cause treatment to stall and even simple movements could be impossible without adequate monitoring. You will receive an IPR guide recommending reduction of up to 0.5mm  between teeth and at the stage at which to carry this out (normally at the beginning of treatment), but please be aware this is only a recommendation and careful clinical monitoring is required throughout, as well as adequate patient consent.

If space exists in the arch for movement and is still not occurring, it may be important to check for more rare issues such as ankylosis of teeth, movement obstructions or short clinical crowns.

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