Clear Aligner Therapy for the General Practitioner
Intraoral scanner with orthodontic workflow improves efficiency
Robert Pauly Jr, DMD
A 2017 study conducted by the American Journal of Orthodontics andDentofacial Orthopedics found that 71.6% of the general dentists surveyed were performing some form of orthodontics, and that 38.3% of those cases involved clear aligners.1 This new technology has opened doors for general practitioners who want to expand the services that they offer to their patients. A general practitioner will tend to select less complex cases than an orthodontist would.2 Cases involving simple tooth movement can be treated by the general practitioner with the use of an intraoral scanner and clear aligners, without having to refer patients out to an orthodontist.3
Typically, adults are the best candidates for clear aligner therapy,4 especially those who had braces when they were younger and have since experienced a relapse-a common occurrence for anterior mandibular teeth. Patient compliance also plays a role in the success of clear aligner therapy, which is why working with adults who are financially invested in the case often results in some of the most successful treatment. The opportunities to suggest clear aligner therapy to patients are numerous. Sometimes, patients complain about teeth that have shifted after having lost a retainer years ago, or they ask what can be done for a smile that they feel self-conscious about before a big event, such as a wedding or a reunion. The doctor may also notice spacing or crowding during a new patient examination. In addition to the cosmetic benefits, studies have shown that clear aligners offer benefits to periodontal health and improve doctors' ability to perform minimally invasive restorative dentistry.5 Some patients will jump at the idea of a cost-effective solution that saves them a trip to a specialist, whereas others will say, "Not now," but the seed has been planted that their general practitioner could provide them with this additional service.
Once a patient has expressed interest in clear aligner therapy, it's a simple process to take a digital impression with an intraoral scanner. Rather than expend the time, effort, and materials needed to take a traditional impression, using an intraoral scanner that features an orthodontic workflow makes capturing full arches quick and easy. Another benefit of using intraoral scanners for clear aligner therapy is their accuracy when compared with traditional impressions.6
After the STL file of the impression is uploaded to a clear aligner manufacturer's portal, the doctor sits down with the patient and shows him or her a roadmap of the planned treatment (ie, length of treatment time, virtual before and after images, etc). Because this process is digital, it can be accomplished at little to no cost to the patient or practice before the decision to accept treatment.
Case Report
A patient presented to the office with slight crowding on the lower arch (Figure 1 and Figure 2). A dual-arch scan was captured using an intraoral scanner (CS 3600, Carestream Dental) (Figure 3), and the STL files were uploaded to the clear aligner manufacturer's (ClearCorrect) portal. A suggested treatment plan was presented to the patient, who then accepted treatment (Figure 4).
The first goal was to achieve an interproximal reduction of 0.3 mm between teeth Nos. 30 and 29 and between teeth Nos. 22 and 20 (Figure 5). The patient was given two sets of aligners to be worn for two weeks at a time. At week 7 of treatment, closed contact was confirmed between teeth Nos. 30 and 29 and between teeth Nos. 22 and 20.
The next goal was to obtain an additional 0.3 mm of interproximal reduction between teeth Nos. 30 and 29 and teeth Nos. 22 and 20, as well as 0.3 mm of interproximal reduction between teeth Nos. 25 and 24. Engagers were placed on teeth Nos. 7, 10, 26, 25, 24, 23, and 20 (Figure 6). The patient wore the next set of aligners for 2 weeks before returning for a follow-up, then continued treatment at home for an additional 2 weeks. At week 13, closed contact was verified between teeth Nos. 30 and 29, and the patient received the next set of aligners (Figure 7). The patient continued treatment at home, receiving new aligners until week 25 when closed contact was verified between teeth Nos. 22 and 20 (Figure 8). The engagers were then removed from teeth Nos. 7 and 10.
The last scheduled set of aligners were received by the patient at week 31 of treatment. They were worn for 2 weeks before the patient returned for a final evaluation. At that time, the engagers were removed from teeth Nos. 26, 25, 24, 23, and 20, and the patient was transitioned into a retainer (Figure 9). Ultimately, the case took 8 months and achieved a total interproximal reduction of 1.5 mm (Figure 10 and Figure 11).
When compared with traditional orthodontic treatment, the relatively quick turnaround and competitive pricing associated with clear aligners make them attractive to responsible patients who are looking to correct minor issues. Studies have even shown that correcting crowding with clear aligners can have beneficial effects on the appearance of ageing.7 In addition, the use of digital impressions and treatment planning keep costs low for both the patient and the practice. Because the relationship that a family dentist has with his or her patients is usually built on years of appointments, offering clear aligner therapy can be a comfort and convenience for patients who stay with the doctor that they know and trust.
About the Author
Robert Pauly Jr, DMD
Private Practice
Union City, Georgia
References
1. Heath EM, English JD, Johnson CD, et al. Perceptions of orthodontic case complexity among orthodontists, general practitioners, orthodontic residents, and dental students. Am J Orthod Dentofacial Orthop. 2017;151(2):335-341.
2. Best AD, Shroff B, Carrico CK, et al. Treatment management between orthodontists and general practitioners performing clear aligner therapy. Angle Orthod. 2017;87(3):432-439.
3. Rossini G, Parrini S, Castroflorio T, et al. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. 2015;85(5):
881-889.
4. Kim TW, Echarri P. Clear aligner: an efficient, esthetic, and comfortable option for an adult patient. World JOrthod. 2007;8(1):13-18.
5. Boyd RL. Periodontal and restorative considerations with clear aligner treatment to establish a more favorable restorative environment. Compend Contin Educ Dent. 2009;30(5):280-286.
6. Nedelcu R, Olsson P, Nyström I, et al. Finish line distinctness and accuracy in 7 intraoral scanners versus conventional impression: an in vitro descriptive comparison. BMC Oral Health. 2018;18(1):27.
7. Patini R, Gallenzi P, Meuli S, et al. Clear aligners' effects on aesthetics: evaluation of facial wrinkles. J Clin Exp Dent. 2018;10(7):e696-e701.
