This article is sponsored content brought to you by SmileStyler.
Since their inception in late 2016, SmileStyler’s mantra has been “Driven to Discover Better” to improve on the current clear aligner offering to clinicians and patients. This has resulted in two unique points of difference; Phased Treatment, and direct local support. Through excellent service and Phased Treatment, SmileStyler has grown their provider base to over 600 dental practices and earned the ADIA 2020 Innovation Award.
Many aligner systems manufacture and send the entire set of aligners based on the first digital or physical impression. The manufacturer stakes the patient’s treatment on the hope that each aligner will fit throughout treatment, which is inherently presumptuous, as:
- Not all tooth surfaces can be captured for conditions of moderate to severe crowding, due to tooth overlap and hidden key anatomical surface data that define the tooth’s shape;
- A patient’s biological response to treatment is impossible to predict. Additionally, some movements are more difficult to plan and execute than others. For these reasons, the lag in tooth movements at any stage of treatment will cause a mismatch between the pre-programmed movement of the aligner and the actual position of the teeth;
- IPR can be performed during treatment changing the shape of the tooth which isn’t captured upon the initial impression;
- More dentists want to incorporate restorative work into their patient’s orthodontic treatment, but the initial impression will not capture these changes as the treatment alters the tooth anatomy.
All the above points can cause gaps between the aligner and the teeth and impact how effectively the aligner fits throughout treatment.
Dr. Geoff Hall, a leading orthodontist and lecturer in Australia, says, “The two most important criteria for orthodontic success are to have the correct treatment plan and to make sure the aligners are fitting perfectly at each and every visit. If these criteria are met, the clinical outcome will exceed everyone’s expectations.”
If aligners do not fit, a new impression must be taken, another treatment plan is made, more aligners are manufactured, and the remaining aligners are discarded. This setback is referred to as a refinement and these refinements will also cause significant delays in the patient’s treatment.
To ensure each stage fits, SmileStyler manufactures in Phases, a limited set of aligners. Towards the end of each Phase, a new digital impression is uploaded and SmileStyler compares the predicted tooth movements to the current position of the teeth. This analysis is used to determine how the next Phase of aligners are manufactured. In addition, all physical changes to the teeth are captured, whether it is due to IPR or a restorative procedure.
SmileStyler Phased Treatment Case Study: Crowding – Lower Incisor Extraction Case
The patient exhibited Class I malocclusion, severe lower crowding and rotations. The treatment goal was to resolve anterior crowding and improve the arch shape. This treatment plan was created to address the patient’s concerns:
- Expansion of upper and lower arch and de-rotation of the anteriors to improve arch shape
- Extraction of the 41, close anterior spaces and correct anterior inclination.
- Maintain upper midline and align lower midline to be centered on the mid of tooth 31.
- Treatment to finish within 18 stages
After patient approval, treatment progressed as follows:
Phase 1: Consisting of aligner stages 1 – 6, the treatment was initiated with lower arch expansion to create space with no movements planned for the 41. At aligner stage 5 the 41 was extracted and a new scan was taken to capture the mesial sufaces of the 31 and 42. The patient continued wearing stage 6 while Phase 2 was being analysed and manufactured.
Phase 2: This phase consisted of stages 7 – 12. Treatment continued with extraction space closure and the rotation of the 42. The additional tooth surfaces captured at the end of Phase 1 for 31 and 42 were fundamental in ensuring that the aligner fit throughout the phase. A new scan was taken at stage 11, and the patient continued wearing stage 12 while Phase 3 was being analysed and manufactured.
Phase 3: This final Phase of treatment consisted of aligner stages 13 – 18. The focus was to close the residual spaces and finalise rotations.
SmileStyler’s Phased Treatment captured all available tooth surfaces and positions throughout the treatment to ensure accurate aligner fit. This provided flexibility in accommodating the extraction of the 41 at stage 5 and ensured that the anterior crowding and arch shape was improved within the prescribed 18 stages.
Article by Dhanie Naidu