Coming from separate fields of dentistry, an orthodontist and a general dentist meet in the middle for their choice of an effective clear aligner treatment method that leads to successful patient outcomes
Cars and aligners in the same sentence? Maybe. If you thought choosing a new vehicle and choosing an aligner system had nothing in common, think again! No one purchases a new car without comparing features among several models, and it’s no different with the multiple lines of clear aligners now available. Whether your specialty is general dentistry or orthodontics, the goal remains the same: to offer patients an effective clear aligner treatment that will give them a straighter smile.
Jeffrey R. Briney, DDS, a general practice dentist in Dana Point, CA, and Mark Lowe, DDS, an orthodontist in Fresno, CA, are 2 clinicians with different specialties, yet their conversation about moderate and complex aligner cases centers around a common theme: the growing list of advantages they’ve discovered with ClearCorrect clear aligners. Their conversation begins with ClearCorrect’s trimline, and both believe it’s a distinct advantage when comparing ClearCorrect aligners with the wealth of similar treatments on the market.
Move Those Teeth!
ClearCorrect clear aligners are available with a performance trimline that is both high and flat, which extends 1 and 2 mm above the gingival margin.
“I really like the original high trimline and studies have shown that it increases retention and can help decrease the necessity of engagers,” shared Dr. Lowe. “There are some instances where I would request a low trimline, such as when I need to decrease retention in restorative areas where there may be undercuts that prevent ease of aligner placement or removal. This occurs more often with older patients who tend to have implants, fixed bridges, or multiple crown restorations.”
“ClearCorrect aligners work more efficiently due to its trimline,” said Dr. Briney. “I use the high and flat trimline in 98% of my cases because of the research that proves where the forces are applied to each tooth and that is at the body or neck. This high trimline feature of the ClearCorrect aligner allows for the aligner to actually engage the tooth at the body without flexing like a scalloped aligner. A tooth moves more effectively and efficiently when moved from the neck versus the incisal edge resulting in less need for engagers to achieve a more predictable result.”
While ClearCorrect’s trimline generally requires less engagers—a boost for patient comfort—they are necessary for certain movements, and as a result, the ClearCorrect treatment method includes a host of add-ons, including cut-outs and engagers—also known as attachments or buttons.
Add Engagers to the Mix
Available in 2-, 3-, and 4-mm lengths, engagers are small shapes of composite material—similar to small resin bumps—that are placed on the facial surface of the tooth, which facilitates aligner attachment. Engagers are often necessary when teeth are shaped or positioned in a way that makes it challenging for the aligner to stay in place.
“Engagers can also be used to assist in correcting difficult movements such as rotations and extrusion,” said Dr. Lowe.
“They can be optimized in terms of shape, dimension, and orientation to help direct the tooth according to the direction of force being used.”
And Slits & Cut-Outs, Too
Dr. Lowe also uses slits and cutouts when adding elastics to this treatment. “Class II and III elastics can be used to correct sagittal issues, while cut-outs can be used for adding buttons, which can anchor elastics and guide teeth in different directions, especially vertical movement or extrusion of the teeth—the most difficult movement for clear aligners to correct,” he shared.
“Cut-outs allow us to do what I call a hybrid technique, which combines buttons and elastics along with aligners, so that we can more efficiently achieve certain movements,” Dr. Briney said. “I used to have to make the cutouts manually myself, but now the aligners arrive with those cutouts necessary for the movements we need. We don’t have to use multiple engagers on each individual tooth, and that’s attributed to the trimline options.”
Anterior Bite Ramps
Anterior bite ramps can be placed lingually in the upper anterior region on some or all central incisors, lateral incisors, and canines. Available in 3- and 5-mm depths, and designed for treating deep bites and crossbites, bite ramps prevent the opposing arch from interfering with tooth movements and create premature contact in the anterior, allowing tooth movements or corrections to take place.
“I routinely use bite ramps to achieve additional intrusion in the anterior, especially for the maxillary central incisors and the mandibular incisors,” shared Dr. Lowe. “I use them to help resolve deep bites. They can be customized to solve different bite issues and may also be used for additional disclusion when correcting cross-bites.”
“I use bite ramps in my Class II or Class III cases in order to achieve a full-arch correction,” Dr. Briney added. “The incorporated bite ramps provide a great way to orthodontically move teeth in cases where we want to correct crossbites and open bites in order to provide a stable and harmonized occlusion.”
Unique, Tri-Layer Material
ClearCorrect clear aligners are made with ClearQuartz, a unique tri-layer material composed of rigid outer layers, and an elastomeric inner layer.
“ClearQuartz is far superior by how it adapts to each individual tooth providing a more consistent orthodontic movement throughout the course of treatment which results in a case that finishes,” said Dr. Briney. “The combination of ClearQuartz and the trimline is what I attribute to the success of my cases with minimal revisions,” he added.
“The outer layers provide durability to eliminate any distortion or tearing of the aligners, which would increase treatment time and inefficiencies in treatment,” Dr. Lowe shared. “The inner, elastomeric layer results in a gentle, consistent force leading to more efficient and predictable tooth movement, which ultimately is the holy grail of clear aligner treatment.”
