Five Common Mistakes to Avoid in Aligner Treatment
In my years practicing and teaching orthodontics, I've seen some recurring mistakes in aligner treatments, ones I even made myself early on. Avoiding these pitfalls can greatly improve the predictability and quality of your outcomes with aligners. Here are the five most common mistakes and how to steer clear of them.
Mistake #1: Improper Staging
One of the biggest mistakes is not paying close attention to staging during simulation reviews. Treatment planning with aligners involves mapping out the movement of each tooth in a specific sequence. Failure to correctly stage tooth movements can lead to compromised predictability, making the desired outcome more difficult to achieve. Ensure you analyze each simulation and break down which teeth are moving at what time. Proper sequencing will help guide effective, logical movements, optimizing the aligner’s effectiveness.
Mistake #2: Performing IPR Too Early
A common issue I see is performing interproximal reduction (IPR) too soon. Many treatment plans place IPR at the beginning, when teeth are most crowded. This timing makes it nearly impossible to measure IPR accurately and can make the process uncomfortable for both clinician and patient. A better approach is to wait until the teeth are more aligned and accessible, making IPR easier to measure and apply. This timing enhances both predictability and patient comfort.
Mistake #3: Neglecting Aligner Chewies
Aligner chewies, though simple, can make a significant difference in treatment outcomes. They’re small, rubberized devices patients chew on to seat the aligners more effectively on their teeth. Chewies increase the contact between the aligner plastic and the tooth surface, which improves the “tracking” of the aligner on the teeth. Without this improved engagement, the aligners won’t fit as accurately, and treatment predictability can decrease. Emphasize the importance of using chewies regularly to your patients—they’re one of the most efficient ways to keep the aligners on track.
Mistake #4: Changing Aligners Too Quickly
Patients often think faster aligner changes will speed up treatment, but in my experience, a 7-day interval is generally too fast. I find aligners don’t fully express their intended movement within this time. For most cases, I start with a two-week interval and may reduce to 10 days later if the patient demonstrates good compliance. However, I rarely go below this. The specific stage of treatment also matters: for complex movements, I stick with a longer interval to ensure full tooth movement before transitioning. Resist the urge to accelerate changeovers—this is one area where patience yields better results.
Mistake #5: Not Using Elastics
Elastics tend to cause confusion among many clinicians, but they are an invaluable tool in aligner treatment. Where aligners push, elastics pull, providing the needed force for difficult movements like extrusion or closing extraction spaces. I also use elastics for troubleshooting when tracking issues arise, as they can help realign teeth when they start to go off course. They’re also essential when dealing with extractions, where they aid in bodily movement rather than just tipping. Learning how to incorporate elastics effectively will significantly enhance your control and predictability in aligner treatments.
Orthodontic Learning Points
Ensure proper staging and sequencing during simulation reviews.
Delay IPR until alignment improves.
Prescribe aligner chewies at the correct frequency
Avoid rushing aligner change intervals.
Master the strategic use of elastics to support complex/difficult movements.
By keeping these points in mind, you can avoid common aligner treatment pitfalls and deliver more consistent, predictable outcomes. Remember, each of these techniques contributes to a smoother, more effective patient journey.
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