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Planning Restorative Treatment after Aligners

Adult orthodontics often combines orthodontic and restorative treatments. These cases involve more than just straightening teeth—they require a holistic, pragmatic approach to address the patient’s aesthetic and functional concerns.


To achieve seamless results, planning for the restorative phase must begin on Day 1. Here’s how to optimize the post-orthodontic restorative process to ensure predictable outcomes for your patients. Read below or watch the YouTube video here.





1. Assess the Smile Line and Lip Line

The journey starts with a comprehensive assessment of the patient’s smile line and lip line. These factors determine the amount of gingival display during smiling and help you decide whether gingival architecture will need adjustment.

  • High Smile Line: Patients with a high smile line often display gingival margins prominently. In these cases, tooth positioning must account for gingival zeniths to create a balanced aesthetic.

  • Low Smile Line: For patients with a low smile line, the gingiva is less visible. Here, focus on aligning the incisal edges for a natural and functional outcome while minimizing restorative interventions.


Key Takeaway: Early assessment of smile and lip lines informs whether to prioritize gingival alignment or incisal positioning in your treatment plan.



2. Address Tooth Wear and Anatomy

Adult patients often present with teeth of varying sizes, shapes, and degrees of wear. Differential tooth wear can complicate orthodontic treatment if not accounted for from the outset.

Incorporating these variations into your aligner simulation ensures that orthodontic movements are tailored to the patient’s existing tooth anatomy. This is critical for achieving harmonious results, especially when planning restorations like composite buildups.


Orthodontic Learning Point: Consider differences in tooth anatomy and wear when planning orthodontic movements to avoid surprises during the restorative phase.



3. Plan the Restorative Space

One of the most common challenges (and mistakes I see) in adult orthodontics is ensuring there’s enough space for restorations. Whether you’re planning edge bonding or full-coverage restorations, the inter-occlusal space must be adequate to accommodate the restorative material.


Aligner simulations should include this space from the beginning to avoid complications later. Without proper planning, you risk inadequate thickness for restorative materials, compromising both aesthetics and resistance form.



4. Incorporate Aligner Overcorrection

Opening the bite is often necessary to provide clearance for restorations. Overcorrection in aligner plans is essential to achieve this vertical clearance.

Provide detailed instructions to your aligner lab or manipulate the simulation yourself to ensure:

  • Sufficient overbite reduction.

  • Adequate space for restorations.

  • Smooth transition to the restorative phase.


Key Insight: Planning for overcorrection prevents last-minute adjustments and ensures the restorative phase progresses seamlessly.



THE MAIN POINT: Plan on Day 1

Post-orthodontic restorative treatment isn’t a step you consider at the end of aligner therapy—it’s an integral part of the initial planning process. By assessing smile lines, accounting for tooth wear, and ensuring restorative space and vertical clearance, you can deliver outstanding results for your adult orthodontic patients.


Orthodontic Learning Points:

  • Assess the lip line and gingival display early to inform treatment planning.

  • Account for tooth anatomy and wear in aligner simulations.

  • Build restorative space into your plan to ensure material thickness.

  • Include overcorrection to create vertical clearance for restorations.


With proper planning, you’ll seamlessly integrate orthodontic and restorative care, providing patients with beautiful, functional results that last.


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