Only fully erupted permanent dentition (no primary teeth or erupting teeth)
Ensure enough clinical crown is available to support the aligner and facilitate movement
X-rays (Ceph or Pan) is a critical tool to ensure no impacted, non-erupted or missing, or ankylosed teeth and to assist in the diagnosis of developmental concerns that may be needed to take into consideration for treatment planning and candidacy
Patient needs to be committed, motivated and responsible – compliance is key
Ideal cases are where space can be created through expansion and proclination, with limited IPR. Mild to moderate crowding is acceptable. Avoid severe malocclusions.
Avoid Cases with deep curves of Spee in the lower arch (ie lower incisors over erupted)
Avoid Possible over advancement of the lower incisors
Avoid iatrogenically induced gingivalrecession especially in the lower anterior region
Avoid larger open bites extending beyond the anterior segments
Tips for Treating Teens
Check the amount and stage that IPR is required. Make use of an IPR gauge.
Manage expectations:
Both parents and teens need to be committed, motivated and responsible
Some discomfort might be experienced during initial changes, but it is much less than traditional braces
Wearing aligners consistently is the best predictor of a successful outcome
Retention – explain that this stage is as important to prevent relapse
Pay attention to the placing of composite attachments.
Retention is non-negotiable.
Instructions to the treatment planners, and case review, are extremely important.
To help with compliance by making aligners easier to remove and replace initially before engagers are placed, consider requesting that treatment planning makes provision for adding engagers at stage 3 of treatment.
Emphasize the importance of using chewies to make sure the aligners seat properly.
The Pros
Final outcome is predetermined thanks to CAD (computer aided design) and individualized treatment planning. Outcomes are predictable.
Due to teens being in a period of active growth, treatment is faster and more efficient. Recent studies have shown that aligner treatment is usually faster than traditional braces
Trays are all delivered together to you, the dentist. A patient therefor does not need adjustments every couple of weeks but simply need to change trays every 2 weeks (or can be sooner at Doctor discretion and patient compliance) with follow up appointments every 6 weeks – this means less chair time for you and your patient
More flexibility in food choices allowing for healthy eating habits to be maintained
No cutting of lips and cheeks by brackets – more comfortable
Allows for better and more convenient oral hygiene, plaque control (limits the risk of white spots and gingival inflammation), periodontal health (less irritation of soft tissue) and overall comfort
Transparent – allows for greater self-confidence
Fewer emergencies if compared to traditional braces – no need to skip school due to broken appliances or injury during contact sports (a gum guard may be worn over the aligners if need be)
The Cons
Removeable – they need to be worn up to 22 hours a day. If not, traditional braces may be a better option.
Can be lost –however, replacement aligners are prioritized for manufacture
If not seated correctly, correct movements will not happen – monitoring is essential
Quality of impressions cannot be over-emphasised. Aligners need to fit 100%
Once the occlusion has settled, a second phase may be required for the final alignment
Some teens prefer traditional braces with colourful accessories
