By Dr. Mark-Anthony Meghie-Shepherd, MDDr.

Mark has been a seasoned dentist and one of the leading clear aligner providers in Ireland who now owns Love to Smile, a complete clear aligner experience studio in Dublin, Ireland

Dentists administering aligner treatment know how lengthy the process can be and the commitment needed to consistently wear the aligners as prescribed. Some patients may be instructed to wear their aligners 18-22 hours a day for 1 week, while others may wear them for 2, 3 weeks, or longer. One thing is certain however: when teeth have moved into the correct position, the patient is ready to move onto the next aligner stage.

So the major question is: how can you improve the patients’ treatment so their teeth track correctly, to speed up treatment, boost compliance and eliminate delays?

Let’s consider a few things before diving into a few tips:

1. It takes time for teeth to move - On an average, each aligner will move teeth 0.2 to 0.35 mm during its wear cycle. It usually takes about 2-4 days for the tooth to move, but it may take a week or two for the alveolar bone to mould to the new tooth position.

   
   

2. Consistent pressure moves teeth - When an aligner is inserted, it feels tight and the patient may experience some discomfort. This is because pressure is needed to push the teeth into the desired location. Without consistent pressure, the teeth will always want to move back to where they were, known as relapse.

   
   

3. Tooth movement is an Inflammatory and healing process: The pressure applied to the teeth causes an inflammation in the local alveolar bone. Inflammation causes blood to flow around the roots and periodontal ligament which sets off several reactions to help the teeth move. Osteoclasts cause some bone to break down when pressure is applied to the teeth, osteoblasts build up and heal bone as the teeth move into the correct position.

   
   

4. Aligner fit is everything - Aligners work by fitting almost perfectly onto the teeth. Aligners with significant gaps between the tips of the teeth and the aligner base (aka Incisal Gaps) means they’re not engaging the teeth well enough to complete the intended movement. Always remember, the better they fit, the better they work!

So considering these points, what can you do to improve and speed up your treatment?

1. Start wearing the aligners before bed - After the last meal for the evening and brushing, this is the best time to pop in a new set of aligners. This allows the aligners to be worn for 5-8 hours or longer completely uninterrupted throughout the night. Some patients report even sleeping right through potential discomfort. Starting during the day may cause major interruptions to the initial wear period from meals, work, life priorities, etc.

   
   

2. Consistency - Wearing the aligners is in the hands of the patient, they must understand these points! Wearing the aligners for less than the prescribed time causes relapse, delaying the process. Touch on these points with your patient: (1) metal braces are worn for 24h/day, aligners need similar consistent wear time, (2) They have the freedom to take the aligners out for 2 hours daily and longer for some people. That’s equivalent to 3 x 30 min sessions to eat, 4 x 2 min sessions to brush, and 22 minutes to split up for snacking or other activities, (3) They shouldn’t keep the aligners out for the full 2 hours straight. Organization and education are the keys to great habits.

   
   

3. Stimulate the treatment with Chewies - Stimulation is a key factor for treatment success and can be accomplished by chewing on “Chewies” with the aligners seated over the teeth. These are rubber appliances provided by the clinician. Lightly chewing on them for 5-10 minutes, 2-3 times a day can help physically push the aligners onto the teeth so they fit well and work better. Chewing also helps with the inflammatory process and creates the needed blood-flow in the alveolar bone and PDL to assist rapid tooth movement and adjustment to their new position.

   
   

4. At-home treatment observation - Teach your patients what to look out for during the aligner process. Advise them to regularly observe their aligner fit to make sure they are fitting over the teeth snugly. Let them know small incisal gaps are normal when a fresh aligner is started, but the teeth will eventually move into these spaces, returning to a snug fit. They should also know basic troubleshooting or reach out to the Dentist/Orthodontist ASAP so issues don’t progress, causing delays.

   
   

5. Take action early - If incisal gaps are present after a week or two of wearing the aligners, request more consistent chewie use, chewing lightly for 20 mins 2-3 times a day. It's best not to delay as the aligners will become less elastic the longer they are worn or distorted if they are not fitting properly. Chewing on the chewies hard may not have any greater effect aside from breaking the chewies. Light and steady is key. You can suggest they throw on their fav series or if they’re at work, to chew, chew, chew!

   
   

6. Educate your patient thoroughly before treatment - Several patients end up wasting time and prolonging their treatment by making up their own routine, unnecessarily changing their aligners too soon or wearing them too long. Aligner therapy is a science which should be followed as closely as possible for the best results. The better the patient understands this, the better the compliance and inevitably, the better the results.

In Conclusion - Starting the new aligners at night and wearing them consistently ensures the proper time and pressure needed to move the teeth and allow the bones to heal. The first 2-3 days of wearing each aligner are the most important for consistent wear to move the teeth more accurately and prevent relapse. Simulating the treatment using Chewies helps the aligners fit better, so they work better, while creating vital blood-flow in the alveolar bone and PDL. Teaching the patient to observe their aligner fit will alert them when to take early action or reach out to the dental professional. Instruct your patient thoroughly so they don’t veer from the given instructions.

Knowledge is Power, Smile Genius :)

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* This article is not intended to deliver medical advice. Please ensure you are qualified to administer Clear Aligner therapy and understand the procedure fully before treating any patients.