Troubleshooting Techniques

When treatment goes off track or you have trouble achieving difficult movements, there are techniques and tools you can use to help.

• Tools: Treatment auxiliaries; buttons, elastics, pliers.
• Technique: Backtracking.
• Technique: Extrusions - with buttons & elastics.
• Technique: Intrusions? - with Chewies and/or buttons & elastics.
• Technique: Rotations - with Dimples' or buttons & elastics.

Button & Elastic: Buttons allow for easy elastic placement. Elastics allow for additional forces to be applied to teeth or segments of teeth and help with anchorage.

They can be used for:

• Extrusions 
• Intrusions 
• Rotations 
• Class Il corrections

Dimples & Pliers: Dimples can add retention. Dimples can also create additional force.

They can be used for:

Technique: Backtracking:

Say there is a poor fit on aligner #15.

1. Ask the patient to return with the aligners they have "worn and saved" OR request remakes of the step(s) needed.
2. Starting with the current aligner (#15),have them try the previous set (#14). If it does not fit satisfactorily, try on the next previous aligner (#13). Repeat until you find a set of aligners that fit well, (let's say, for the sake of example, #12 fits well).
3. Then with the aligner that fits well (#12),have the patient begin wearing the next aligners in sequence, (#13) for 2 weeks each.
4. Progress forward through the series until reaching the last aligner that did not fit well (#15),then continue moving through the series of aligners as long as each aligner fits as it should.

Techniques: Extrusion with Buttons & Elastics

• Extrusions are one of the more difficult movements to achieve with clear aligners.
• As always, the patient must wear the aligner (and elastic) for a minimum of 22 hours each day, or the process will not work.
• Watch for extrusions not occurring with your cases, as this can be one of the reasons a patient's treatment has gone off track.

Parts needed: 

Techniques: Intrusion with Chewies

When an intrusion is not tracking or needs extra pressure/force you can use Chewies.

You can have the patient use the Chewies until the aligner seats completely.

Techniques: Intrusion with Button & Elastics

Buttons and elastics can also be used to help with intrusions.

Techniques: Rotations with Buttons & Elastics

-Rotations are also one of the more difficult movements to achieve with clear aligners 

-When a rotation is not tracking or needs extra pressure/force you can use buttons and elastics

Parts needed:

The elastic is worn until the rotation is corrected or slightly overcorrected.

Techniques: Rotations Using Dimples

When a rotation is not tracking or needs extra pressure/force you can also use dimples.

The force made by dimples will only be as strong as the aligner's strength, so it's best to place dimples in a fresh aligner that has not been worn yet.

Note: The amount of tooth movement with dimples is limited as there must be adequate space on the opposing side of the dimple within the aligner to allow the tooth to move. Often this is limited to the size of the air gap between the aligner and the tooth.

Parts Needed:

-Dimpling pliers

-Aligner

Be aware that different manufacturers make dimpling pliers that produce slightly different-sized dimples and some pliers require heating while others do not. Refer to the pliers manufacturer for specific instructions.

Techniques: Dimples for Added Retention

To add additional retention to aligners:

-Place a dimple between two teeth on the lingual and facial sides of the aligner.