Overview: This article provides clinical guidelines for determining if your patient is a candidate for aligner treatment and defines the differences between refinements, revisions, and refabrications.
Clinical Eligibility Criteria
Clear aligner treatment is indicated for orthodontic patients who meet the following clinical parameters:
Patients present with Class I malocclusions.
Patients present with mild to moderate crowding.
Patients present with mild to moderate spacing.
Patients experience orthodontic relapse from prior treatment.
Patients require tooth alignment prior to restorative dental procedures (such as crowns, veneers, or implants).
Patients maintain excellent oral and periodontal health.
Patients demonstrate complete compliance with treatment protocols and oral hygiene requirements.
Clinical Treatment Limitations
Clear aligner treatment is contraindicated for patients with complex orthodontic conditions. Clinicians must refer patients presenting with the following conditions to a licensed orthodontist:
Patients possess mixed dentition.
Patients possess impacted or unerupted teeth.
Patients possess ectopic or severely displaced teeth.
Patients possess extensive dental restorations.
Patients require tooth extractions.
Patients exhibit a reduced periodontium exceeding 33% bone loss.
Patients possess insufficient clinical crown height.
Patients possess ankylosed teeth.
Patients possess dental implants that prevent orthodontic movement due to osseointegration.
Patients present with severe crowding exceeding 8mm.
Patients present with mutilated dentition.
Patients present with Class III malocclusions.
Patients present with overjet or overbite measurements exceeding 3mm.
Patients present with multiple teeth in crossbite.
Aligner Plan Modification Definitions
Clear aligner treatment plan modifications are classified into refinements, revisions, or refabrications based on the approval and manufacturing status of the clear aligners.
Clear Aligner Refinements
A clear aligner refinement is necessary when an approved and manufactured treatment plan requires further adjustments after patient implementation (for example, if the patient is unsatisfied with the clinical outcome after using the final aligner tray).
To request a refinement:
Navigate to the Orders tab within the Dandy Portal.
Locate the specific clear aligner order requiring modification.
Click Request a Refinement.
Note: New intraoral scans are mandatory for clear aligner refinements. New clinical photographs are optional for clear aligner refinements.
Clear Aligner Revisions
A clear aligner revision is necessary when a treatment plan requires adjustments prior to manufacturing. If the treatment plan is unsatisfactory during the review phase, the clinician must reject the treatment plan and detail the required clinical improvements within the Dandy Portal.
Clear Aligner Refabrications
A clear aligner refabrication replaces existing physical trays without altering the underlying clear aligner treatment plan. Refabrications apply to specific operational and clinical scenarios:
The patient lost the clear aligner trays.
The patient broke the clear aligner trays.
The clear aligner trays contain manufacturing defects, causing patient discomfort.
The clear aligner shipment was lost in transit.
The clear aligner trays present fit issues caused by intraoral scan distortion.