‘Failed clear aligner cases can ruin lives’ – where to turn for help

32Co is free to join and offers one to one specialist orthodontist support on every clear aligner case and four-week CPD courses launching monthly


Even the best clinicians can run into trouble with clear aligner cases from time to time – 32Co explains how collaborating with a specialist orthodontist can keep you out of trouble.

This three-part case study series discusses clear aligner claims. It will also explain how dentists can help prevent similar situations from happening to them.

If you’re a clear aligner provider seeking advice on a case, request advice from a 32Co specialist orthodontist via the Clear Aligner Case Hospital form. Perhaps you’re unsure if  you should take on a case, or the case isn’t progressing as expected. It could even be a past case that didn’t go to plan. If selected, you’ll receive 15 minutes of one to one support for free.

Hurry! This hotline is only open for a limited time.

As an exclusive partnership benefit, Dental Protection members skip the queue for the 32Co Case Hospital.

Through this series, Dr Yvonne Shaw, deputy dental director at Dental Protection, Dr Sonia Szamocki, founder of 32Co, and Professor Ama Johal, specialist orthodontist and clinical lead at 32Co, will explore three examples of clear aligner claims and consider what dentists can do to help prevent these situations from occurring in the future.

Which aspects of clear aligner cases can be tricky?

Every patient is different. Even with most clinically sound plans, sometimes ‘life happens’. This can keep a clear aligner patient’s smile journey from going exactly as planned.

When providing clear aligners there are three main areas dentists can seek specialist support in. These may help to reduce the risk of a problem arising and create the most predictable treatment outcome for patients:

  • Assessing case complexity: gaining a better understanding of the presenting malocclusion will allow an optimal approach to viable treatment options and equally identify any associated risks
  • Improving treatment plan accuracy: get it right the first time and experience fewer refinements
  • Addressing mid-treatment complications: identifying the root cause and the best action plan.

‘Part of our work at Dental Protection is to understand the themes that drive claims and cases so we can share insights and support members in providing optimal care for their patients. What we often see is that when a claim is settled, it is because of a problem identified with the assessment or original treatment plan ie right at the start of the patient journey. In legal terms, this “problem” would be called a “breach in care”.

‘However, that breach may only impact the case many months after treatment has started or it doesn’t come to light until after treatment is completed. An example of this would be relapse due to teeth being left in an unstable position,’ shared Dr Shaw.

‘Dr. Shaw and I have been looking at the root cause of a number of claims which highlighted how limited training or inexperience can be an underlying factor. It is easy to consider that, if the dentist had been working with a specialist and had received thorough training, the circumstances for the patient could have been much different,’ said Dr Szamocki.

Claim case study: background

  • Dentist notes: my patient came to me wanting to improve the alignment of her anterior teeth and improve the colour. She is due to get married in six months so would like any course of treatment to be completed by then
  • Initial clinical examination by the dentist: the patient has good oral health and is therefore a suitable candidate to undergo clear aligner treatment
  • The treatment proposed and initiated by the dentist: alignment of the upper anterior teeth.
Patient dental panoramic tomography

Claim case study: discussion

What’s the problem?

‘While the dentist appeared to have checked all the boxes in their submission steps to assess a case before starting treatment, the dentist unfortunately failed to spot a significant hidden complexity that turned this otherwise straightforward-looking case to one that became unsuitable for treatment. Note the highlighted supernumerary on the OPG, which is adjacent to the roots of the incisors,’ shared Professor Johal.

Patient dental panoramic tomography with the hidden complexity circled

What is the role of specialist mentors in assessing clear aligner case suitability?

Dr Szamocki’s perspective

When we survey dentists, we often see that understanding which cases are suitable for treatment is the biggest concern. Everyone has heard of and some have experienced nightmare clear aligner cases.

Orthodontics is a speciality for a reason. It isn’t fair or reasonable to expect general dentists to have deep expertise in every dental speciality. This especially the case when there is hidden complexity. So why not borrow some of that knowledge from a more experienced specialist orthodontist colleague?

Dr Shaw’s perspective

As well as needing the skills and experience to assess treatment options, a further challenge presents in ensuring that the outcome that can be achieved will meet the patient’s expectations. Failure to meet expectations is a factor in a large number of complaints. It is incredibly important to spend time at the outset to understand whether the patient’s vision is realistic and achievable. An experienced mentor can help you establish this.

Closing Notes

Keep an eye out for part 2 of the series releasing soon. In the meantime, 32Co is free to join and offers one to one specialist orthodontist support on every clear aligner case and four-week CPD courses launching monthly. Check us out.

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