Dental Tribune America

Clear aligner therapy: Begin with the end in mind

By Ken Fischer, USA
April 28, 2016

Forty-one years ago, when I began my journey as an orthodontist, I was fortunate to have been invited to associate with Dr. Robert Ricketts and Dr. Ruel Bench in their Pacific Palisades, Calif., practice. During those 11 years of working closely with them, I learned many valuable lessons, but the one I call upon every day in my practice is to “begin with the end in mind.” In other words, visualize the treatment objectives before starting the treatment.

Ricketts and Bench developed and promoted the Visual Treatment Objective, or VTO, as a technique to create that visualization.

Today, the emergence of clear aligners as an accepted modality for orthodontic treatment has brought us the digital VTO in the form of a treatment setup. Once the software technician has manipulated the original digital models to represent a satisfactory treatment goal, not only is the new occlusion visualized but the sequential pathway from beginning to end animates how the teeth will move to arrive at their destination.

Anyone who has moved teeth with clear aligners understands just how important it is for the clinician to master the nuances of the treatment setup. This mastery begins with the information and direction the clinician provides the technician before the software moves a single tooth.

The technicians’ skill set grows with their experience in creating the setups; however, it is much better when they understand clearly what objectives and preferences the doctor wants to achieve with the treatment. Remember the adage, “garbage in, garbage out”? Well, it can be very aptly applied here.

For example, ClearCorrect provides forms in its online portal for the doctor to submit the information the technicians will need to reset the teeth, and additionally, areas where the doctor can provide further directions to aid the technician in staging, engager placement, IPR, etc. Therefore, ClearCorrect allows for greater doctor control over the treatment plan and offers more flexibility to reach the desired goals.

Once the original treatment setup is completed, the doctor must scrutinize it, starting with the final result: Does it meet the clinician’s objectives for occlusion, interdigitation, appropriate overbite and overjet, rotation correction, staging or treatment time and facial esthetics? If the criteria are met, the setup is approved and the fabrication of the aligners begins; if the doctor rejects any part of the setup, the doctor submits his objections and instructions for correcting or improving the identified issues and the setup is revised. Within a couple of days, the review process is repeated.

ClearCorrect does not charge a fee for preparing the treatment setup or even multiple setups in case the doctor would like to visualize alternative treatment plans, e.g., in borderline cases where extraction may result in a more favorable result than non-extraction.

Setups can be prepared for each scenario, giving the clinician the opportunity to analyze both results and approve the one that would best meet the treatment objectives. Additionally, ClearCorrect works with most intraoral scanners, making it easy for clinicians to submit cases and allows for more precise treatment setup plans.

Even after the final approval of the original setup, the value of the digital VTO lives on. It offers the doctor an opportunity to demonstrate the treatment goals to the patient visually.

Although not required to do so, showing the setup to patients stimulates their anticipation to begin treatment and raises their confidence in the clinician’s competence.

The setup can also be an important tool for monitoring progress throughout the treatment. When aligners are not “tracking” adequately, often the reason why can be determined by analyzing the staging amounts in the setup.

The technology that has made orthodontic treatment with clear aligners possible has also digitally re-shaped the appearance of Ricketts’ and Benchs’ VTO and made it a much more powerful and valuable tool, now known as the treatment setup.

Rearranging teeth on digital models, sequential staging of tooth movement, enhanced graphics, online communication between clinician and technician, and competitive pricing all combine to make the utilization of this valuable tool available to any who are willing to learn how to properly apply it.

Where Invisalign once held the competitive advantage, ClearCorrect is rapidly emerging as many clinicians’ choice as their clear aligner provider. The doctor can feel confident that the ClearCorrect aligners will produce the same results as any other aligner system; it is only the clinicians’ experience and training that determines the quality of their orthodontic treatment. ClearCorrect does, however, offer a subset of unique benefits:

  • An aligner trim line research-proven to be optimally effective;
  • A simplified, efficient online case submission portal;
  • Aligners delivered in phases for doctor convenience;
  • The opportunity for the clinician to choose one-, two- or three-week wear schedules;
  • Acceptance of a large number of various scanners for submitting digital models; and
  • A $25 discount if digital scans are submitted in lieu of PVS impressions.

About the author

During his 41 years as an orthodontic specialist and after treating nearly 1,500 clear aligner cases, Dr. Ken Fischer enthusiastically offers clear aligner treatment to most of his patients, including those needing four bicuspid extractions. He frequently lectures and has published a number of articles on clear aligner treatment.

This article was published in Ortho Tribune U.S. Edition, Vol. 11, No. 1, AAO Preview Edition 2016.


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