Precision Align Co.

What to do when teeth don’t move using clear aligners

Now What?  What to do when teeth don’t move using clear aligners

The consultation went great, particular, to pivot and adapt to the times by taking advantage of the wealth of resources becoming your patient is ready to start their clear aligner treatment and so you start creating your patient’s treatment plan. Everything is going smoothly for the first couple weeks, but soon your patient’s teeth aren’t moving as they should. What now?!
Fortunately, unmoving teeth is a common issue that arises during treatment. Typically, there are a few reasons that would prevent teeth from moving properly or as they should be; the most common reasons are because the projected movement itself is unpredictable, there wasn’t enough space for a tooth to move prior to treatment, or because the patient isn’t being compliant with the treatment plan by not wearing the retainers as prescribed.

If your patient is compliant, then it’s time to go back to the drawing board. You want to ask first if you are creating a predictable tooth movement. If you are creating an unpredictable movement, such as trying to dystallize a third molar into the ascending ramus of the mandible (which is impossible because there’s a bone wall there), or pure extrusion of lateral incisor, you may want to explore the option of adding auxiliaries.

If the tooth movement is both predictable and the patient is compliant, there may be friction occurring so that the teeth aren’t moving the right way. For instance, when you extrude a tooth, you’re bringing a tooth into a narrower space but in order for that tooth to come in, there has to be space made for it to fit.
So what can be done about teeth not moving as expected? This is the time to stop, drop and listen! Is there a predictable movement? Is there enough space? Something you’ll want to do when you’re dealing with complicated cases like this is to have a chair side lightning strip so that you can make sure the interproximal contacts are relatively loose. If you are doing an extrusion of a lateral or some other similar movement, you’ll want to see your patient a little more regularly to ensure compliance and to have the opportunity to run that lightning strip through the interproximal spaces to make sure there isn’t contact or friction in between the teeth.
For complicated cases with more significant problems, you’ll need to use elastics to make sure you’re bringing those teeth into place, as you won’t want to automatically jump into a refinement (keep in mind that refinements result in more overhead and more discomfort and/or pain to your patient). Before having your patient move on to the next tray, make sure the tooth is moving into place; you don’t want to rush the process since it will cause delays later on. One way you can address complicated cases is by using one of two types of elastic attachments. The first, a bootstrap elastic, works by having a button that attaches to a single tooth on the facial and lingual surfaces which allows the tooth to move where it needs to go. The second, an intermaxillary elastic, works by creating a triangle formation with two buttons on the lower arch that are cut out of the aligners and one on the upper arch that allows for a canine or lateral tooth to be brought down or to rotate a canine.

Are you ready to add Precision Align to your practice?  Reach out to the team here to get started today!