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Special Issues
July/August 2023
Volume 44, Issue 1
Peer-Reviewed

A Clear Aligner Case Treated Without Attachments

R. Bruce McFarlane, DMD, BScD, MClD

The patient, a 54-1/2-year-old woman, presented to the author's clinic with chief concerns of crowded lower incisors and feeling pressure on the upper anterior teeth coming from the lower anterior teeth. She was interested in clear aligner orthodontics, with treatment as fast and "invisible" as possible. With a diagnosis of a class I crowded deep bite narrow-arch malocclusion, a course of treatment was initiated with Reveal® Clear Aligners (Henry Schein Orthodontics, revealproviders.com). The first Studio Pro™ treatment setup predicted 25 upper and lower aligners with no attachments and no interproximal reduction (IPR). Two-week intervals per aligner were prescribed initially, transitioning to 1-week intervals at 8 weeks. The author typically starts with 2-week intervals to ensure the patient's compliance and biology are in place; an evaluation of the tracking at stage 4 usually guides the author toward a 1-week interval from there on. The Reveal aligner system typically requires only one case refinement because of the accurate expression of the plan and the greatly reduced need for overengineering. The first round of aligners was completed at 7 months. A case refinement of 20 aligners was then completed in 4.5 months, with some minor IPR in the lower incisors. The patient was happy with the outcome and delighted that it was accomplished without attachments.

Key Takeaways

With the Reveal® Clear Aligners system, predictable orthodontic movements in three dimensions can be produced without the use of attachments.

Two-week intervals are recommended at first, especially in adults, to ensure the cellular activity is activated and the aligners are tracking well for the first four aligners.

Interproximal reduction (IPR) may be necessary in adults once crowded teeth are unraveled to eliminate dark triangles. Waiting for a case refinement makes the areas requiring IPR more obvious and accessible.


About the Author
R. Bruce McFarlane, DMD, BScD, MClD
Private Practice in Orthodontics, Kenora and Thunder Bay, Ontario, Canada; Fellow, Royal College of Dentists of Canada; Diplomate, American Board of Orthodontics

Fig 1. Patient’s pretreatment smile.

Figure 1

Fig 2. Pretreatment, frontal intraoral view.

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Fig 3. Pretreatment, right lateral intraoral view.

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Fig 4. Pretreatment, upper dentition, occlusal view.

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Fig 5. Pretreatment, lower dentition, occlusal view.

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Fig 6. At 7 months, frontal intraoral view.

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Fig 7. At 7 months, right lateral intraoral view.

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Fig 8. At 7 months, upper dentition, occlusal view.

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Fig 9. At 7 months, lower dentition, occlusal view.

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Fig 10. At 11.5 months, patient’s smile.

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Fig 11. At 11.5 months, frontal intraoral view.

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Fig 12. At 11.5 months, right lateral intraoral view.

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Fig 13. At 11.5 months, upper dentition, occlusal view.

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Fig 14. At 11.5 months, lower dentition, occlusal view.

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