Recently I was giving a consultation to a young woman who was interested in clear aligner orthodontic therapy. After determining she was a good patient for aligners and the protocol of use, I brought up the fact that once treatment is complete she might need a “refinement”. After all trays are completed the teeth may not be where we expected them to be at the end of treatment. In these cases new impressions are taken and more trays are used to obtain an optimal result. These refinements may need to be done several times to achieve proper results. On rare occasion some brackets may need to be placed to finish treatment. After this explanation she asked me an interesting question, “if they use this sensitive computer technology to produce my trays and you have a computer work up of how my teeth should look at the end of treatment, why would I need a refinement?” Now on the surface this might seem like a simple question with a response like, “well things don’t always work out like they are supposed to.” Instead I found myself saying that even though they use sensitive computer programs to accurately predict the teeth’s final position, “biology doesn’t always follow technology.” The more I thought about that statement I realized this didn’t only apply to aligners but all of orthodontics. There are so many factors that go into one’s individual biology; it is no surprise that a computer would not be able to fully predict how teeth are going to move. When it comes to fixed braces this is exactly why we treat the mouth from visit to visit. Of course we have a general treatment plan with certain goals in mind, but we must constantly adjust to what we did the last visit. This is one of the things I love about orthodontics; the constant problem solving that must be done not only at the start of treatment but every visit. This brings me to my main point, although aligner therapy plays an increasingly important role in orthodontics, it is extremely important for the doctor and patient to understand that they should not be used on all orthodontic cases indiscriminately. Some tooth movements are much more predictable than others and the success rate with clear aligners are not equal for all cases. It is also paramount that you see a dentist who has a lot of experience with aligner therapy and can determine what kind of orthodontic therapy would be best for your individual case.
