Sound orthodontic knowledge imperative for clear aligner treatment

By Dr Hasse Lundgaard DDS, Master of Orthodontics (UK)

There is a saying:

“The true measure of one’s skills is how one makes a success of a case that does not go ‘by the book’”. 

And a statement:

“The expected high quality of an aligner treatment, is a result of the quality of the treatment information from the dentist to the aligner technician, who in turn uses this information to program the aligner software”.

It is very important to understand that aligner treatment is an orthodontic treatment. Hence, any dentist offering this treatment needs to have a basic understanding of biomechanics and the general orthodontic principles.

Worrying trend

There is a worrying trend that is detrimental to the future reputation of dentistry. It is estimated that more than half of all dentists offering aligner treatment only send in scans or impressions of their patient’s teeth to the aligner laboratory. They then leave it to the laboratory technicians to program the software with only this information. That is because those dentists have very little, or even no knowledge about orthodontic principles, or what they are doing, and rely on the technicians and their computer software alone to design the treatment.

Let’s compare this to what could happen in a parallel situation in medical surgery, where robots – via a software program – take over and do some type of surgery, with the doctor knowing little or nothing about what is going on!

This is of course NOT the case, NOT the case at all.

It is obvious that the medical doctor would have done extensive preparatory work, made a full and detailed treatment plan before using the computer-based robot. The medical doctor is of course, at all times in full overall control of what the robot is doing and understands every single part of the treatment in detail.

And again of course, the doctor bears full RESPONSIBILITY for the TREATMENT. If he did not have a full and detailed knowledge about the procedure, he would be in serious trouble with the Medical Association or even worse, he may be causing irreparable harm to the patient.

It is a fact that some general dentists starting out on the Aligner Therapy, are doing so without the necessary basic orthodontic knowledge – and it is taking precedence over other types of dental treatments. This means that these dentists are starting a new kind of dental treatment, without really knowing what they are doing. Patients would of course at some stage become aware of this and this would over time ruin the patient’s trust and eventually damage the reputation of the dental clinic.

The big picture

The computer-based aligner treatment is a relatively new orthodontic system. Patients do not clearly understand as yet what to expect and who has the responsibility of the treatment when something does not go to plan.

Orthodontists have for decades used the Fixed Brace System to align teeth in the most optimal way. With this system, the quality of the treatment is always the first priority, that is, to obtain perfectly aligned teeth, with an optimal static and functional occlusion, within a framework of excellent aesthetics.

When the new Aligner System came along, it was viewed as a much more aesthetical and comfortable orthodontic appliance to wear than the Fixed System.  Orthodontists would now take this system into consideration when they need to inform patients about the different options to treat a malocclusion, crooked teeth etc.

In the end, the treatment system offered to the patient should always be the one that the orthodontist believes would give the best result.

And the orthodontist will of course have an overall picture of all the orthodontic problems and state if the problems were skeletally or dentally related etc. – something a dentist without some orthodontic knowledge would be unable to perceive. A correct and detailed diagnosis is so vital for making the detailed overall treatment plan.

The biological process isn’t always predictable

It is obvious to assume that aligner patients will soon become more aware of the reasons when the treatment outcome does not line up with the computer software’s predictions. And they will no longer accept answers like: “It is computer based”, or “Something has gone wrong with the calculation”, or “Sorry but that is what can happen with a computer software and that is out of our hands” – all of which translates into “it is not our responsibility”.

Aligner patients will normally, at the start of a treatment, be shown the final result that the software has calculated. But research studies have shown that on average, at least 20-30% of all cases show that the final outcome is NOT as the computer has predicted.

The reason for this is because orthodontics is a BIOLOGICAL PROCESS that no computer software program or any clinician has full control over.

In the Fixed Orthodontic treatment System, it is possible to change the strategy, appliance design and the Treatment System as soon as something does not go to plan. But in the Aligner Treatment System everything must be planned in advance or at the refinement stage.

The other important issue is the patient’s compliance and cooperation, which will not be known at the start of a treatment. 

On average, in at least 20-30% of the cases, refinements will be needed, where extra aligners are required to finish the treatment and obtain the optimal results.

In such a situation, the aligner dentist, after consulting with the patient, must now modify the treatment and send the new details to the CAD Aligner Technician to alter the software program and thus finish the Patient’s Aligner Treatment satisfactorily.

It’s your (LEGAL) responsibility

It is very important to understand that the dentist is the ONLY person who has seen the patient, talked to the patient, heard about the patient’s MAIN problems, concerns etc. and therefore knowing all the details, can inform the Aligner Laboratory about the appropriate treatment plan.  It is also important to bear in mind that the software cannot consider or control the soft tissue, does not know about the gingival situation, the functional occlusion etc.

It is understood that all the essential details from a Patient’s Questionnaire and all the essential details of a thorough Clinical Examination and correlated analysis of the Patient MUST be informed, in full, to the Aligner Technician for him to program into the software.

It is important to understand that it is the dentist alone who has the full responsibility of the Aligner Treatment and its outcome. It is NOT the responsibility of the Dental Technician, nor the Aligner software. An ALIGNER Dentist CANNOT blame the computer in any way for a bad Treatment result.

More newspaper articles and information from Orthodontic Societies state that it is essential for “ALIGNER DENTISTS” to possess fundamental knowledge, understanding and professional insight of the ORTHODONTIC ALIGNER SYSTEM, and that it is, in itself, an ORTHODONTIC TREATMENT.  

Aligner lawsuits have already started in relation to companies and dental clinics offering Aligner Treatment without a competent practitioner and a fully appropriate and professional treatment assistance.

It is now more important than ever to ensure that all dentists who are offering the Aligner treatment, have found ways to educate themselves about Orthodontics and Aligners, so that they have a very good basic understanding of Biomechanics and the Orthodontic Principles.

Introducing “ALL in ONE”, ORTHO X ALIGNER

The “ALL in ONE”, ORTHO X ALIGNER program has been created and developed as a unique tool to obtain, step by step, this basic and essential knowledge of the Orthodontic Aligner Therapy, by “Learn by Action” and the “Logic Approach”.

ASSIST – STUDY – LEARN. This required ‘mindset change’ of dentists, to obtain that essential orthodontic skill, will first and foremost benefit the MOST IMPORTANT PERSON of all, the patient. But certainly, it is also for the benefit, pride and self-esteem of the dentist, and it will of course, also very much benefit the reputation of dentistry in general.

By using the ‘ORTHOXALIGNER’ program for each new patient, the dentist will benefit from continuous learning and understanding about the Aligner Treatment and this basic knowledge will be invaluable and important for the dentist in the future competitive world of aligners.

Pamphlets worth checking out

Informing patients in a professional and very informative way about the Aligner Treatment from the very start and throughout the whole treatment, is very important.  Consequently, we have also created and included ORTHO- ALIGNERS PAMPHLETS in our Program, to fully equip and impress the information upon your patients.

One of the pamphlets is EXTREMELY IMPORTANT: The “Patients General Information and Explanation” Pamphlet.

This informs them about all the important and necessary responsibilities a patient has in connection with their Aligner Treatment and also states that they have been clearly informed about all parts of an Aligner Treatment, including the possible risks etc.

The contents also include information about what a Patient can and cannot complain about; what they cannot blame the dentist for etc. There is extensive and important information in this 15-Page Pamphlet that we call: “The Legal Paper”.

In summary

The Ortho X Aligner Program is a Clear Aligner “All in One” online patient treatment and management platform dedicated to assisting dentists worldwide to incorporate the Aligner treatment system into their dental practice. This program includes a comprehensive patient information package; detailed information illustrating the orthodontic principles of the clear aligner system; along with step-by-step instructions.

The mission of Ortho X Aligner is to provide the general dentist with a basic knowledge and tools needed to provide their patients with clear aligner treatment using the step-by-step process to guide them through the clear aligner system.

At Ortho X Aligner we believe that the foundation for success in any dental practice is knowledge acquisition, skills development, and professional support, coupled with an effective treatment strategy and personalized patient care plans. As a result, Ortho X Aligner has created a program to address some of these needs and incorporates these values in a comprehensive support system.

Click here for more information on ORTHO X ALIGNER.

Disclaimer: The views and opinions expressed in this article are those of the author/s and do not
necessarily reflect the policy or position of the publisher Dental Resource Asia.