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Many dental professionals are apt to file a clear aligner treatment under the “cosmetic” label. Straighten the teeth to achieve an upgraded smile, and the process is done. Right?
But ask a clinician who’s watched a ClinCheck turn into a patient returning with sore muscles or an opening bite, and they’ll tell you that there’s a difference between straight teeth and stable teeth.
The key is to see how clear aligners fit into a larger, more holistic treatment approach. To illustrate the point and the process, Dr. Andrew Reingold recently walked through his approach – and how the Dawson Academy principles of stable occlusion and healthy TMJs underpin the argument.
The short version? The magic of the process is in the plastic, not the planning.
Today’s aligners are very effective at moving teeth. A well-followed aligner protocol can address everything from mild crowding to severe malocclusion.
But what if “Can we straighten these teeth?” is the wrong question?
According to Dr. Reingold, the better question is “Does the way we plan to straighten teeth create occlusal stability? Does it protect the gums, bone, roots, muscles, and joints altogether?”
Asking this question is the first step in building a repeatable system that leads to a longer-term solution that gives the patient a more holistic outcome.
The principles we find in the Dawson method give us four treatment options:
Aligners fit in that second tier of treatments, but they rarely work on their own.
If you can plan the repositioning and restoration together (on the same screen and in the same workflow), you’ll end up with a much more predictable result that solves more than just a “straightness” issue.
A modern scan can capture more than just a tooth’s shape. It can document the gap between the dental bite (MI) and the skeletal bite (centric relation, the seating of the condyle in the joint). You can see that and act, but what if you could show the patient the before and after as well?
Add in a leaf gauge, and you gain a heat map of contacts in centric relation and documentation of the very first point of contact. What once happened behind the scenes in analog records can now be shown to the client in real time.
Reingold notes that it’s this patient interaction that drives higher case acceptance. People can understand a picture of their own bite, and it personalizes the final potential result.
This is a simple move, but it can do much of the heavy lifting in a treatment case – even before a single aligner is created.
To show an example of this in action, consider Becky. She comes into your practice showing a deep bite and crowding. When you ask, she complains of morning muscle soreness.
You treat her, and the correction itself took fewer than 20 aligners. Much of the deep bite was gone well before treatment started – all by planning to CR.
How did this work? In order to open her deep bite, you might think that the best move is to intrude the lower anteriors (absolute intrusion).
But the faster route would be relative extrusion – upright the lingually flared posterior teeth and the cusp tips swing into earlier contact along the arc of closure. In this way, a half-millimeter of premature posterior contact can open more than a millimeter anteriorly.
Remember, your ClinCheck is showing intent rather than the final dynamic you’ll see in the patient’s mouth. If you set up a perfectly tight anterior in the software, you’re more than likely planning for an interference. Even the most modern software can struggle to predict what ends up being common collisions – and a little overjet can help here.
It’s well documented that aligner thickness can intrude posterior teeth. This, in turn, can turn the lower anteriors into an interference – which you don’t want to happen.
Since the mandible closes up and – importantly – forward along its arc of closure, you compensate in advance.
One of the most important steps? Stay involved in the process, even if it’s the last 10%. You bring experience and expertise to the process.
Even though the software is incredibly effective, don’t offload the entire process to the algorithm or technician. Have them get you to 90%, then take direct control over the 3D finishing yourself.
At first glance, it can seem as though the step-by-step digital approach takes more time. But in reality, it does the opposite.
Work the mandibular incisal plane first, then build upward, and make sure to include checks and balances at each step. This methodical process results in a shorter and much more definitive path.
The fundamentals that Peter Dawson taught for decades still apply now. Digital tools simply allow you to run 2D and 3D simultaneously and test-drive the occlusion well before it reaches the patient’s mouth.
It’s the difference between hoping a case finishes well and knowing that it will because of the planning that went into the entire process. And with the workflow built on records you’ve already gathered, you remove the guesswork that so often ends in remakes and refinements. The less you see your patient for callbacks, the better!
These ideas from Dr. Reingold are only one of many hands-on courses available with the Dawson Academy.
You can learn more in Clear Aligner Therapy for Complete Dentistry – a two-day Dawson Academy course that covers much more, including occlusion-based diagnosis, digital records workflows, ClinCheck Pro®, Smile Architect®, biomechanics, and much more.
Plus, you’ll get a complimentary Invisalign® certification upon completion of the course.
Watch the full webinar online and learn more about Dr. Reingold’s course at The Dawson Academy.
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