As more people look to straighten their teeth, the use of clear aligners has led to rising interest among patients and practitioners — with the end result that more offices are adding this esthetic therapeutic option. Beyond a discrete appearance, demand has also increased as indications for aligner treatment have grown. “Today’s aligners are not what they were 15 years ago,” notes Ricky E. Harrell, DMD, MA, program director for the Georgia School of Orthodontics in Atlanta. “Advances in technology have increased the scope of what can be treated with aligners.”
Factors boosting patient demand include appearance, convenience and fewer office visits. In addition, oral hygiene is easier because the appliances are removable. Providers also benefit, as less time is needed for appliance maintenance compared to fixed orthodontics. Additionally, Harrell says decalcification is not seen to the same extent in aligner patients as those being treated with traditional methods. “Aligners are also self-governing,” he adds, “meaning that a set of trays can only accomplish the tooth movement that was programmed into them. They cannot cause unintended movement, as can happen when maintenance is lacking with fixed appliances.”
Before adding aligner services, providers need a clear understanding of orthodontics and the limitations of tooth movement, and have access to technology that allows adequate documentation for treatment. This includes radiographs of the teeth and surrounding bone. A panoramic radiograph is just a portion of the diagnostic record, however, as Harrell asserts cephalometric imaging is “absolutely necessary” to plan safe tooth movement.
Additionally, clinicians should understand the types of cases indicated for clear aligner therapy, and which patients require orthodontic referral. “Fixed appliances can be used to manage almost all orthodontic situations,” Harrell explains. “Aligners cannot make the same claim, so their range is more limited.” He suggests most general practitioners limit treatment to mild to moderate Class I malocclusions for correction of rotations and malalignment, as well as cosmetic changes. In cases involving malocclusions with a moderate or significant skeletal component, referral to an orthodontist is recommended. Collaboration is also needed anytime the dentist realizes treatment is not progressing as expected.
Of course, patient cooperation is key to treatment success. If aligners are not worn as prescribed, the result will not necessarily reflect the anticipated outcome. According to Harrell, “Noncompliance not only produces inferior outcomes, it also takes longer to achieve these substandard results.”
Similarly, providers should be cognizant of situations in which this modality is an inferior choice to traditional orthodontics. Although practitioners highly experienced in aligner therapy are treating some fairly difficult cases, this approach is generally not as effective for managing mild to moderate skeletal discrepancies as fixed appliances, he explains.
As an orthodontist with nearly four decades of experience, Harrell bristles at the idea of do-it-yourself aligner therapy in which a clinician is not present to examine the patient’s oral and orthodontic condition. “This is simply bad medicine,” he says. “When we do not incorporate an oral screening and examination as part of treatment, we allow the opportunity for many conditions of pathology and disease, both oral and systemic, to go undiagnosed.”
As the scope of what is treatable with professionally supervised aligner therapy broadens, the advantages of this approach — an esthetic appearance during treatment, easier maintenance and oral hygiene, plus shorter treatment time — will continue to fuel growing demand among patients and providers.
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