“With great power comes great responsibility.” In the context of clear aligners, “power” may be defined as the ability to move teeth almost invisibly. The aesthetic benefit no doubt comes with great responsibility with a high demand for patient compliance. As a second year resident, treating only a fraction of my patients with clear aligners, I am continuously learning about the benefits of clear aligners as well as the challenges that come with them.
Clear aligners attract patients of any age, especially adults who often have high aesthetic demands. I have seen popularity with clear aligners in patients whose occupation requires a great deal of speaking such as in meetings where teeth are constantly visible to others. Clear aligners also work well in patients who have had previous treatment with full fixed appliances that need correction after minimal relapse who prefer not to fully commit to brackets again.
From a practice management perspective, treating with clear aligners may help to decrease chair time thus allowing for more patient appointments within a day. After bonding attachments and fitting new trays, appointment times may be kept to a minimum to deliver additional trays and assess fit. Intervals between visits may increase as patients often do not need to be evaluated monthly. Additionally, use of clear aligners often involves less breakage and thus fewer emergencies.
Clear aligners provide many advantages for orthodontic practice and patients, however that is not to say they do not come with challenges. With any removable appliance, they can become lost or patients may not wear them as recommended which may alter the progression of treatment, potentially slowing it down and increasing the need for multiple refinements. A common challenge that often occurs is lack of tracking especially with lateral incisors. As patients often receive multiple trays at a time, tray order may be improperly followed if patients are not attentive to which tray number they are on. Many of these challenges are often addressed with refinements, however multiple refinements may put patients at risk of treatment burnout.
Despite the advantages and challenges of using clear aligners it is very important to educate patients on the expectation and responsibility of this treatment method. Clear aligners may not be the best treatment option for every clinical diagnosis. Therefore, assessing every patient both in their malocclusion and their motivation for compliance presents a paradigm shift in patient selection. Personal expectations and lifestyles factor in greatly when deciding the most appropriate treatment approach.
Use of clear aligners in clinical practice is a treatment method that will continue to increase in popularity. With the selection of the appropriate patient and case difficulty, successful results are very achievable. Therefore, developing knowledge and experience with clear aligner therapy is an important skill for new orthodontists to have.
Stephanie Colaiacovo (PGY2 Buffalo)