CLEAR ALIGNERS

Submitted by
Dr Prairna Zaroo Kalia
Mds 2nd year
CONTENTS
> Introduction
> Advantages
Brief history of clear aligner treatment
Impression techniques and digitization
> what is Clin check software ?
> Smart Force features and Attachments
Biomechanics
> Clear Collection instruments for clear aligner
treatments
> A Clinical Case Treated with Clear Aligners
> Accelerated Extraction Treatment with
Invisalign
> Periodontal considerations
> Summary
 Clear Aligners are an alternative to traditional
braces and are designed to help guide teeth
into their proper position.
• Similar to braces, clear aligners use a gradual
force to control tooth movement, but without
metal wires or brackets.
• The aligners are made of a strong plastic
material and are fabricated to fit each person's
mouth. If a series of aligners are made, each
aligner moves the teeth a little bit more into
place until the desired movement is
completed.
• Aligners are worn for at least 20 hours a day
to reach the desired maximum effectiveness.
• Each aligner is worn for three weeks before
changing to the next one. The length of
treatment with aligners depends upon the
severity of each case.
• Typically, aligner treatment can be as short
as three weeks or as long as six months. Still, a
much shorter treatment than traditional
braces. Each aligner is designed to move the
teeth a maximum of about 0.25 to 0.3 mm
over a 2-week period, and is worn in a specific
sequence.
• The Invisalign appliance is currently
recommended for adults and for adolescents
with fully erupted permanent teeth who meet
an acceptable standard of compliance.
• Excellent compliance is mandatory since the
appliance has to be worn a minimum of 20 to
22 hours a day and each aligner should be
worn 400 hours to be effective.
Scheau et al proposed the first thermoforming
machine to synthesize orthodontic appliances
in 1966.
• Currently 2 types of thermoforming
machines ,The Ministar and Biostar (scheau
Dental)
Clear aligners are removable so it is easier for
you to brush and floss after meals.
• Clear aligners are easier to keep clean.
• Clear aligners are comfortable and less likely
to irritate your gums and cheeks.
• Clear aligners can prevent tooth wear from
grinding.
Brief history of clear aligner treatment
• Clear aligner treatment falls into
• ESSIX RETAINER
INVISALIGN
The first category consists of thermoformed
appliances sometimes known as ESSIX
RETAINERS.
• This are fabricated by making adjustments to
the tooth
positions on plaster or stone models and
fabricating one or more aligners to correct a
minor malocclusion.
• The second category is Invisalign is a
proprietary orthodontic technique that uses a
series of computer generated custom plastic
aligners to gradually guide the teeth into
proper alignment.
• It is both a brand name and a technique and
is used synonymously
Invisalign is the only computer aided design
and manufacturing (CAD -CAM) Precision
aligner product available in united states.
• The company and the technique was the
brainchild of two graduate business student at
Stanford university
1997, Kelsey Wirth and Zia Chishti.
Impression techniques and digitization
• Invisalign impression trays are available in
various sizes to accommodate all patients and
can be ordered online for free from Invisalign.
• Specifically designed for Invisalign treatment
planning, the Invisalign trays fit uniquely in the
digital scanners that "read" the impressions.
• Invisalign scanners read only vinylpoly
siloxane (VPS) material, so it is imperative that
other materials (e.g.,alginate alternatives,
polyether materials) not be used
Ideal impression material systems (e.g.
Flexitime, Heraeus Kulzer) include putty and
light wash materials, a combination that
captures the details necessary for creating
Invisalign aligners.
• Such details include all margins and
anatomical landmarks. Additionally, these
materials set easier and avoid running and
slumping.
Ideal impression material systems (e.g.
Flexitime, Heraeus Kulzer) include putty and
light wash materials, a combination that
captures the details necessary for creating
Invisalign aligners.
• Such details include all margins and
anatomical andmarks. Additionally, these
materials set easier and avoid running and
slumping.

Ideal impression material systems (e.g. Flexitime,

Heraeus Kulzer) include putty and light wash

materials, a combination that captures the
details necessary for creating Invisalign
aligners.
• Such details include all margins and
anatomical landmarks. Additionally, these
materials set easier and avoid running and
slumping.
The Virtual Setup
• After the impression arrives at Align
Technology in Santa Clara ,California they are
scanned using an industrial CT scan to produce
a 3D Virtual model.

• Once the Virtual models are produced they

are dermented visins bovindary recognition
software to
• Once the interproximal surfaces of the teeth
are assessed and virtual roots are placed and
lastly the gingival margin also created using
morphing type software.
The preparation work is finished and than
submitted to TREAT (Align Technology Inc).
• It is a Proprietary software that align
technology uses to simulate treatment and set
the virtual model to allow the manufacture of
the aligners.
• Once the virtual model is completed and
approved by the orthodontist, a series of
plastic models is fabricated using
stereolithography on which the aligners are
then made by thermoforming process.
Clin Check ClinCheck-26
• The software used by the orthodontist in the
office is called clin check.
• It allows the orthodontist to view the
treatment in all the aspects as well as
superimpose one stage of treatment over
another to visualize individual tooth
movements so as to gauge the probability of
accomplishing the desired movement that will
be biologically feasible.
Attachments
• The New Attachment Protocol allows for
attachments to be passive or active. Passive
attachments are for aligner retention and
anchorage for intrusion.
• Active attachments are used for rotations of
rounded teeth,
extrusion and root correction. Currently Align
Technology has three types of attachments for
commercial use: the ellipsoid,rectangular and
the beveled attachment.
Vertical rectangular attachments as seen in are
the default for rotations of canines and
premolars.
• In addition, these attachments are used for
root control on teeth adjacent to extraction
spaces. For premolar extraction cases, the
default is placement of two rectangular
attachments distal to the space and one
mesial to the extraction space.
• Typically these attachments are 1mm thick,
2mm wide and either 3, 4 or 5 mm long.
The vertical rectangular attachments are very
retentive, so take care when placing multiple
attachments in one quadrant. The
aligner can become too retentive for patient
convenience. An interesting option is the
beveled attachment for rotations.
• Sometimes the rectangular attachments
don't fit perfectly and during rotation can put
unintended forces on the tooth, resulting in
side effects. Beveling the attachment can ease
the fit and make the attachment "active,"
causing rotation.
Smart Force features and Attachments.
Designed to help you treat with confidence.
SmartForce Features are:
Engineered to deliver the force systems
necessary to achieve more predictable tooth
movements.
Customised to each tooth using advanced
virtual modeling, including such
features as the width, long axis, and contour
of the entire tooth.
Positioned more precisely to deliver the
necessary forces while eliminating
interferences. automatically placed in
accordance to the desired movement.
CAN DE Used as
• For diagnosis and treatment planning
evaluate the need for IP, Expansion,
Extraction, Distalization or proclination.
• For verifying that technician has performed
modifications.
• As a consultation device to show treatment
limits to patient
•For verifying if aligner is tracking.

Biomechanics
" The use of aligners is far more complicated
than most people believe It takes a
knowledgeable clinician with considerable
experience to use the appliance to its
maximum. What that maximum is I don't
know"
• In order to determine just what that
maximum height be with invisalign in its
current rendition of aligner materials, we must
examine the biomechanics of tooth movement
with invisalign.
Aligner Bio-Mechanics!
•By: Dr Willy Dayan
• Willy Dayan's Golden Rules of Invisalign Bio-
mechanics
1) Think Like Plastic and Feel Like a Tooth:
Invisalign is a removable • appliance and thus
cannot glue to teeth in order to "pull" them;
the aligner can only "push" on surfaces of the
teeth or surfaces
of attachments. When a force is placed upon
at tooth, it will
move according to biomechanical principles
that exist, no matter
what the computer screen shows.
[2) The Clincheck Video is not Teeth Moving:
Stop watching the
• ClinCheck movements as "moving teeth!
Think of the images as[8:51 pm, 09/04/2022]
Dr Prairna Z Kalia: Aligner Bio-Mechanics!
•By: Dr Willy Dayan
• Willy Dayan's Golden Rules of Invisalign Bio-
mechanics
1) Think Like Plastic and Feel Like a Tooth:
Invisalign is a
removable
• appliance and thus cannot glue to teeth in
order to "pull" them;
the aligner can only "push" on surfaces of the
teeth or surfaces
of attachments. When a force is placed upon
at tooth, it will
move according to biomechanical principles
that exist, no matter
what the computer screen shows.
[8:51 pm, 09/04/2022] Dr Prairna Z Kalia: 2)
The Clincheck Video is not Teeth Moving: Stop
watching the
• ClinCheck movements as "moving teeth!
Think of the images as
representing the anatomy of the "changing
inner aligner
surfaces", and then analyze the resulting
forces the aligner will
exert upon the teeth.
[8:51 pm, 09/04/2022] Dr Prairna Z Kalia:
Controlling Torque
• A net force of 40gm (base level force of an
aligner after 48hrs)
intended to move the teeth lingually would
require the moment
of 320 to 400g-mm (M/F ratio- 8/10) for bodily
movement or
greater than 400gmm for lingual root
movement.
• Improper attachment design or placement
allows the delivery of
only 280g-mm moment in conjuction with 40g
force resulting in
controlled lingual crown tipping
• It must be kept in mind that the aligner
provides the same level
of force on both sides of the teeth, even
though the forces may be
in opposite direction
[8:52 pm, 09/04/2022] Dr Prairna Z Kalia: This
means that in the absence of spaces to close,
Just as with
fixed appliances, There must be some outside
force system such
as interarch elastics to provide a net distalizing
force on the
maxillary anterior teeth to produce lingual
root movement.
• There is an inherent problem with
rectangular attachments, because it is difficult
for the patient to insert and remove the
aligners.
• If the attachment and the aligner are not
completely coupled then the result is an
unwanted force system and unpredictable
tooth movement.
representing the anatomy of the "changing
inner aligner surfaces", and then analyze the
resulting forces the aligner will exert upon the
teeth.
Controlling Torque
• A net force of 40gm (base level force of an
aligner after 48hrs) intended to move the
teeth lingually would require the moment
of 320 to 400g-mm (M/F ratio- 8/10) for bodily
movement or
greater than 400gmm for lingual root
movement.
• Improper attachment design or placement
allows the delivery of only 280g-mm moment
in conjuction with 40g force resulting in
controlled lingual crown tipping
• It must be kept in mind that the aligner
provides the same level of force on both sides
of the teeth, even though the forces may be
in opposite direction
This means that in the absence of spaces to
close, Just as with fixed appliances, There
must be some outside force system such as
interarch elastics to provide a net distalizing
force on the maxillary anterior teeth to
produce lingual root movement.
• There is an inherent problem with
rectangular attachments, because it is difficult
for the patient to insert and remove the
aligners.
• If the attachment and the aligner are not
completely coupled then
the result is an unwanted force system and
unpredictable tooth movement.