‘From scan to smile’: George Dandanov discusses why you should consider incorporating clear aligner therapy into your practice and the benefits of embracing CAD/CAM technology.
Though clear aligners may seem like a modern development, their origins date back to the early 20th century.
In 1945, Herald Dean Kesling pioneered the concept of using appliances to move teeth without traditional wires or bands. This idea was further advanced in 1959 by Henry Nahoum, who developed the first clear thermoplastic aligner. Nahoum also introduced the use of attachments; small buttons placed on teeth to enhance control during treatment.
Today, with the growing demand for aesthetic dentistry, clear aligner therapy has become a leading orthodontic solution, combining these early principles with advanced CAD/CAM technology for precise digital planning and custom fabrication, meeting patients’ desire for a discreet and comfortable option.
Why should you consider clear aligner therapy?
Newly qualified GDPs should strongly consider incorporating clear aligner therapy into their practice. With patient demand rising for aesthetic, comfortable orthodontic solutions, clear aligners provide a discreet and appealing alternative to traditional braces.
The streamlined digital workflow – utilising intraoral scanners and aligner software – makes integration efficient and manageable for any general dental practice. Additionally, clear aligners offer a profitable opportunity to expand services, retain patients and boost practice growth.
However, successful implementation hinges on a solid understanding of the biomechanics and clinical principles of clear aligner therapy, ensuring effective and predictable outcomes for patients.
Understanding clear aligners
Clear aligner therapy is an orthodontic approach grounded in core biomechanical principles, though it differs significantly from traditional fixed appliances in how forces are applied, engagement is achieved, and anchorage is managed.
In fixed appliances, teeth are moved by pulling forces via archwires and brackets. Clear aligners, however, rely on pushing forces, with aligner material exerting pressure as it deforms over the teeth. The aligner’s elasticity then guides the teeth into the desired position.
Engagement in traditional systems is achieved through archwires secured to brackets, with thicker wires providing more rigid control. In clear aligners, teeth are engaged by the aligner wrapping around them. Teeth with longer crowns have better engagement, while attachments on smaller teeth, such as peg-shaped incisors, can enhance the aligner’s grip, optimising tooth movement.
Anchorage in fixed appliances typically involves reciprocal anchorage, where one segment of teeth stabilises another. Clear aligners offer more refined anchorage control, allowing for specific teeth to be stabilised at various stages of treatment, offering superior management throughout.
Understanding these distinctions is essential for clinicians when deciding between clear aligners and fixed appliances for individualised patient care.
Treatment planning and case selection
Successful clear aligner therapy relies heavily on appropriate case selection, especially for GDPs and young clinicians. To achieve optimal results, align the complexity of cases with your experience level.
As your expertise grows, you can gradually handle more complex malocclusions. For beginners, it’s advisable to start with simpler cases and progressively take on moderate ones before attempting more advanced treatments.
A systematic approach is key: evaluate case difficulty by analysing arch length, vertical, transverse, and anteroposterior discrepancies. This structured method ensures predictable results and helps clinicians develop their skills effectively over time.
Essential techniques for clear aligner therapy
Attachments and interproximal reduction (IPR) are pivotal in optimising the biomechanics of clear aligner therapy.
Attachments, bonded to specific tooth surfaces, enhance aligner retention and facilitate controlled movements like root torque, extrusion, and complex rotations. The strategic placement and design of attachments should correspond to the biomechanical demands of the tooth movement to ensure precision.
IPR, an essential adjunct, alleviates crowding by creating interproximal space, allowing aligners to guide teeth smoothly into position. It should be performed conservatively, following a staged approach for gradual reduction while minimising enamel loss.
In more complex cases, combining elastics and TADs provides additional control over vertical discrepancies and occlusal correction, expanding the scope of clear aligner therapy for GDPs. Mastering these techniques helps achieve superior clinical outcomes and boosts case success rates.
Clinical case example
The patient presented with a class I molar and canine relationship, accompanied by narrowed posterior corridors and a need for expansion.
Notable anterior crowding was observed in both the upper and lower arches, with the upper lateral incisors requiring significant rotational adjustments and extrusion. A carefully planned treatment approach using clear aligners was devised to achieve the desired alignment and functional improvements.
Stage one – rotational adjustments and horizontal alignment
During the initial stage, the treatment focused on horizontal alignment and rotational adjustments. Attachments were utilised to enhance anchorage and facilitate expansion. These attachments provided the necessary control for effective tooth movement and supported the alignment process.
Stage two – extrusion of upper lateral incisors
The second stage addressed the extrusion of the upper lateral incisors. While attachments were crucial in the first stage, the extrusion phase employed buttons and elastics instead, offering a streamlined approach to achieve the desired vertical movement efficiently.
Outcome and results
The treatment concluded successfully with 21 aligners and one refinement stage. The results demonstrate the effectiveness of clear aligner therapy, combined with strategic use of attachments and elastics.
This case highlights the importance of meticulous planning and precise execution in achieving optimal clinical outcomes.
Conclusion
As you explore incorporating clear aligner therapy into your general dental practice, embracing CAD/CAM technology can significantly elevate your treatment outcomes and patient satisfaction.
Take the leap into this advanced, patient-friendly approach with confidence. Should you need any assistance with clinical planning or CAD strategies, I’m here to support your journey. Together, we can harness the full potential of clear aligners and drive your practice’s success to new levels.
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