Take the ‘trouble’ out of ‘troubleshooting’ with Aligner Dental Academy’s guide on how to overcome the most common challenges during Invisalign treatment!
Navigating the challenges of patient treatment is just as crucial as achieving the desired outcome. At The Aligner Dental Academy, one of the most significant barriers we’ve observed, one that deters dentists from continuing with Invisalign, is encountering issues during treatment.
These hurdles not only discourage patients from completing their aligner journey but can also diminish a dentist’s confidence in the product itself.
From our experience in mentoring thousands of cases, we’ve found that the most common obstacles faced by dentists can be easily identified and resolved with the right guidance.
Below, we highlight some of the most frequent troubleshooting challenges in clear aligner therapy and offer practical solutions to manage them effectively.
1. Teeth not tracking in the aligner
Why does this happen?
Teeth not tracking properly in aligners is one of the most common challenges. The issue could either be generalised lagging or localised lagging, each requiring a different approach.
Generalised lagging
When there’s a gap of more than 2mm between the teeth and the aligner, it’s often a sign of generalised lagging. This is typically due to poor patient compliance – not wearing the aligners for the required 22 hours per day.
Solution
If the gap exceeds 2mm, a new course of aligners is needed. Until the new set arrives, provide the patient with an Essix retainer to prevent tooth movement.
Localised lagging
Localised lagging may occur for several reasons, including:
- Insufficient space: inadequate Interproximal Reduction (IPR)
When not enough space is created between the teeth, certain movements, like tooth rotation, may not occur as planned - Insufficient force: attachment loss
If aligner attachments are lost, it can result in insufficient force, preventing proper tooth movement - Loss of anchorage
Anchorage is critical for controlling unwanted tooth movement. In some cases, Class II or Class III elastics may be needed to manage overjet, while retention attachments on the molars (rectangular attachments) can help provide the necessary resistance - Unpredictable movements in the ClinCheck
If multiple complex movements, such as extrusion, root torque, or derotation, are programmed into the same stage, one or more may not occur as expected.
Solution
Reassess the ClinCheck. Look for difficult movements and see if they can be simplified. You may need to modify the treatment plan, possibly shortening treatment time by focusing on the leading movements.
Need more help ClinCheck planning? Attend our ClinCheck online masterclass on 22 November. More information can be found here.
If a single tooth is failing to track, it’s common to encounter a small gap (0.5–1mm) when extruding teeth. Document this gap and inform the patient. Encourage the use of Chewies or Ortho Munchies to help align the teeth within the tray.
If the problem persists or involves multiple teeth, consider stopping the treatment and scanning for additional aligners.
2. Posterior open bite (POB) development after aligner therapy
Recognising a posterior open bite
A posterior open bite (POB) occurs when the back teeth do not meet at the end of aligner therapy. It’s crucial to check the occlusion at the final appointment, as some patients may not notice the issue. Patients might report heavy contact on the front teeth or mention a change in their bite.
POB is often seen in Class III cases where there is a reduced overbite and lower anterior crowding.
Managing POB detected during aligner therapy
- Identifying what teeth are not in occlusion
Use articulating paper to mark which teeth are making contact. If only the anterior teeth are contacting (3-3), with a reduced overjet, it may be necessary to add IPR to the lower 3-3 region and request a 2-4mm overjet from the technician. Also, ensure a post-refinement occlusion review - Retraction control
For cases requiring lower labial segment retraction, Class III elastics can help control the overjet. Precision cuts, button cutouts, and hooks on the upper 6s and lower 3s may be used with medium-force elastics worn for eight hours per day.
For more advice on using elastics during aligner therapy see our webinar on Class II and Class III elastics here.
Managing POB detected after completion of aligner therapy
1. For POB less than 2mm
If the POB is minor, a Dahl appliance may be useful. Cut the aligners distal to the lower canines and instruct the patient to wear them for three to four weeks. This allows the posterior teeth to over-erupt into occlusion
2. For POB greater than 2mm: the box elastic technique
In more severe cases, use the box elastic technique to restore occlusion. Ensure sufficient incisal clearance and incorporate rectangular attachments on the molars for improved anchorage. In deep bite cases, plan for heavy posterior contacts and light anterior contacts.
Struggling to know how to place elastics in your cases? Join our hands on Londec event in March. More info can be found here.
Key takeaways
- Teeth not tracking: address compliance, reassess the ClinCheck for complex movements, and consider the need for additional aligners
- Posterior open bites: detect them early, check occlusion regularly, and use elastics or a Dahl appliance as needed
- Clear aligners: success hinges on patient compliance and careful monitoring at each stage of treatment.
By staying vigilant and applying these troubleshooting strategies, practitioners can ensure more predictable outcomes and smoother treatment journeys for their patients.
All this and much more will be covered at the Aligner Dental Academy’s Annual SAFE Symposium event in London on 8 February 2025. Do not miss your chance to learn and grow amongst your peers at THE event of the year! Click here to find out more.
This article is sponsored by Aligner Dental Academy.
