CATEGORY 44 AUSTRALASIAN DENTIST CLINICAL u True posterior extrusion u Complex vertical corrections In tooth-wear cases requiring vertical control or intrusion, aligners can be effective but must be staged conservatively. Overpromising vertical correction leads to under-delivery and prolonged treatment. 4. Periodontal considerations Adult restorative patients frequently present with: u Reduced periodontal support u Thin gingival biotypes u Recession Aligner movements beyond the alveolar envelope increase the risk of further attachment loss. Orthodontic movements must be planned within periodontal limits, not restorative wish lists. The issue of predictability and refinements Pre-restorative aligner cases often require: u Multiple refinements u Close monitoring of tracking u Adjustments to original restorative plans This is not a failure – it is a reflection of biological reality. However, clinicians must: u Build this into timelines u Coordinate closely with laboratory technicians u Avoid beginning definitive restorations prematurely Starting restorations before orthodontic stability is achieved is a common and costly mistake. Retention is critical in pre-restorative cases Once restorations are placed, relapse is no longer a purely orthodontic problem – it becomes a restorative one. The literature strongly supports longterm or indefinite retention in adult orthodontic patients, particularly when restorations are planned or already present. Bonded retainers and nighttime aligner retainers are often necessary. Retention should be discussed before treatment begins, not after restorations are delivered. A practical OrthoED framework At OrthoED, we teach that clear aligners are an excellent pre-restorative tool when used within a controlled, biologically respectful framework: u Diagnose orthodontic problems first, restorative problems second u Use aligners to position teeth where restorations become minimal u Avoid expansion and proclination as default space solutions u Plan retention as part of the restorative consent u Sequence orthodontics fully before definitive restoration Conclusion Clear aligners have transformed the practicality of pre-restorative orthodontics. They allow more patients to benefit from conservative, interdisciplinary care and enable restorations that are smaller, stronger, and longer lasting. However, aligners do not remove biological limits. Used thoughtfully, they enhance restorative dentistry. Used indiscriminately, they create new problems for restorations to solve. For general dentists, the guiding principle remains: Clear aligners should make restorations easier and smaller – not necessary and larger. When orthodontic principles lead and digital tools support – not dictate – decision-making, pre-restorative aligner therapy becomes one of the most powerful assets in modern dentistry. u Bibliography (peer-reviewed) Proffit, W. R., Fields, H. W., & Sarver, D. M. (2019). Contemporary Orthodontics (6th ed.). Elsevier. Kokich, V. G., & Spear, F. (1997). Guidelines for managing orthodontic–restorative relationships. American Journal of Orthodontics and Dentofacial Orthopedics, 111(3), 228–238. Spear, F., & Kokich, V. (2007). Interdisciplinary management of anterior dental aesthetics. Journal of the American Dental Association, 138(2), 160–169. Magne, P., & Belser, U. (2003). Bonded porcelain restorations in the anterior dentition. Quintessence Publishing. McIntyre, G. T., & Millett, D. T. (2012). The orthodontic–restorative interface. Journal of Dentistry, 40(12), 1119–1125. Rossini, G., et al. (2015). Efficacy of clear aligners: A systematic review. Angle Orthodontist, 85(5), 881–889. Papageorgiou, S. N., et al. (2018). Orthodontic treatment outcomes in adults: A systematic review. European Journal of Orthodontics, 40(5), 463–474. Available from leading dental wholesalers EasyFit™ TePeasy it One brush for small and medium gaps Brush away plaque between teeth One brush covers ISO 2-4
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