Orthodontic treatment by clear aligners

Invisible orthodontics with transparent aligners is certainly not anything new: tested almost 20 years ago, now it counts millions of cases.

Although this technique is widespread, most patients don’t know its methods, directions, advantages and disadvantages…

Aligners: what they are

Clear aligners are nylon moulds of a patient’s dental arches. These arches are made starting from the initial one of the patient, and proceed in a series, progressively varying the position of the teeth. This progressive series of arches is created with very advanced 3D software. The expected movement takes into account the original position, the desirable one and of course the root and the tissues surrounding it. This is all information that the specialist must enter on the IT interface during the orthodontic plan development phase. The patient applies these moulds (called aligners) and changes them every 2-3 weeks. The teeth pushed by the aligner then follow, aligner after aligner, the movement established by the computer simulation.

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When, how long, and how to wear the aligners

The aligners are thin (0.6-1 mm) and transparent, so they can be worn easily at any time.

The aligners must be worn for at least 21-22 hours a day.

The patient wears them all the time and only takes them off to eat or in case of special occasions (important presentations, ceremonies, etc.): the teeth and aligners must be thoroughly cleaned with a toothbrush after each meal. When they are not worn, the aligners can be stored in a small plastic container conveniently kept in a pocket or bag.

The aligners must obviously be changed so that the teeth change position gradually. The time interval between an aligner and the other can vary from 10 to 21 days depending on the specific case.

How long does an entire treatment last?

Each case has specific characteristics, so generalizing is not possible.

• Some patients require minimal time and movements in order not to create harmful stress on the dental ligaments
• on the other hand, young growing patients can move the elements quickly…
• some particularly complex cases require you to start with some softer and thinner aligners to avoid discomfort in applying them and removing them, later moving on to thicker devices once the teeth are aligned a little and
• lastly even more complex cases require that the treatment be divided by scanning the arches again after a certain number of aligners to obtain models that are always extremely precise, to remedy discrepancies and thus always offer the maximum effect… this is generally possible when the production system is completely internal, otherwise the costs and times would become unsustainable.

Particularly complex cases can be solved with multiple scans…

…. offering constantly updated sets of aligners and guaranteeing always very precise treatments and satisfactory results.

Guidelines for treatment with aligners

These devices allow a series of specific movements such as rotations around the dental axis, crown movements around the root tips, and dental extrusions.

To carry out these movements, small attachments (i.e. small extrusions in white composite) are often positioned on the teeth to help control the movement.

However the aligners are not able to effectively perform all the movements… intrusions, translations and sectorial forces between the arches are very difficult and unpredictable:for these limitations, traditional orthodontics with wire and brackets (external or internal) still represent the first choice in case of severe malocclusions and dento-skeletal discrepancies. Especially when these problems create myo-functional disorders.

Therefore: before approaching a treatment with aligners, it’s very important to consider if this is recommended for the specific case.

The experience we now have with this method is quite consolidated and we can therefore easily describe the main clinical recommendations:

Main indications

• Aesthetic alignment of the front teeth (generally without changing the molar occlusion)
• Pre-prosthetic orthodontics (teeth that have lost their original position due to the loss of an adjacent tooth are correctly repositioned before the latter is replaced by a prosthesis)

However, there are less frequent recommendations that are very valid in selected cases

Secondary recommendations

• Open bite correction (after functional swallowing correction)
• As a complementary part to the traditional treatment (for example, as preparation or finalization of the case)
• Specific cases of orthodontics in children and young adults (the main difficulty is the poor cooperation of young patients)

There are obviously many other therapeutic recommendations for which aligners have been used successfully, but obviously it depends on the clinical evaluation of the specific case.

Treatment: how we carry it out

For many years our office has carried out treatments in external consultancy, sending moulds to the United States, planning with an operator in the United States, and finally receiving the treatment set after a few weeks.

Every one of these phases was particularly delicate because an error was very difficult to correct: the distance greatly affected time and costs.

Today, fortunately, our office, thanks to the synergy with the PBalli laboratory (located in the adjacent building) has managed to internalize the entire treatment implementation process.

This has allowed us a simpler workflow, less time and lower costs, but above all greater thoroughness in the treatment.

These are the steps to treat typical cases of frontal aesthetic alignment:

1. First of all, we have a visit with the patient and evaluate his occlusion, his functional integrity and the absence of joint and algic-dysfunctional disorders, thus assessing the patient’s needs and aesthetic requests.
2. Then a 3D scan is performed with our intraoral scanner: this device effectively replaces the traditional (and often unpleasant) paste footprint by offering a highly detailed (0.015 mm) 3D virtual model of the dental arches in two minutes.
3. The laboratory receives the 3D file and analyses it with the newest and most advanced invisible orthodontics software. Our specialists and technicians then develop the treatment plan.
4. The specialist presents the care plan to the patient: time, costs and aesthetic result. If requested, obviously some changes can be made.
5. Once the patient accepts the treatment, in a few days our laboratory develops the sequential models in 3D and creates the aligners from them.
6. At the time of delivery to the patient, the first aligner is applied and the patient is instructed on the correct use of the aligners.

Controlling the whole process: the best guarantee of success

Complete control over the procedure gives us several advantages:

• no misunderstandings; our specialists develop the plan in direct collaboration with the technicians
• halved times and costs
• we can handle even the most complex cases. If necessary we carry out more optical update scans during the treatment, so the aligners are always very precise.
• if the patient would like small further changes once the plan has been successfully completed, we can supply any finishing aligners at no additional costs.