CATEGORY 42 AUSTRALASIAN DENTIST LINICAL Clear aligner is a natural extension of the use of tooth positioners, an appliance first introduced by TP Orthodontics in 1945. The idea was further developed by several clinicians before being combined with advances in transparent thermoplastic materials and computer technology (CAD-CAM, stereolithography and toothmovement simulation software). This has resulted in clear aligner products being made increasingly available and effective for tooth alignment in a variety of malocclusions. According to Boyd, using CAD-CAM, stereolithography and tooth movement simulation software to move teeth incrementally with a series of clear aligners is imperative in determining proper sequencing of tooth movements, tooth attachment design and placement, and prescribing overcorrection when needed for difficult tooth movements. Steps in process of clear aligners u History and clinical examination u Patient selection u Treatment records submission u Treatment plan confirmation u Virtual setup u Aligner fabrication and delivery u Treatment monitoring u Retention Clear aligner therapy Initial Data Recruitment- Record Submission It includes initial assessment, diagnosis, treatment planning and completion of pretreatment records (e.g., panoramic and lateral cephalometric radiographs, bite registration and photos). Clear aligner therapy can be based on the submission stone models, impressions (usually polyvinyl siloxane) or as digital image obtained by scanning a plaster model or taken either by direct impression of the patient’s dentition with an intraoral scanner by the treating clinician. The 3D models produced from the varying sources can then bemanipulated by the orthodontist into the various treatment stages via manual adjustment or by CADCAM technology, and malocclusion is virtually corrected using proprietary software. Treatment plan confirmation When the digital model is created, the file can be loaded in the setup program to start making the treatment plan with the submitted prescription details for tooth movement. Following the setup program, each tooth number is marked on the imported digital model, and the most mesial and distal points of each tooth are marked. After that, the cutting line of the crown is corrected to accurately mark the clinical crown. Next, the crown, root and long axis are set, and the teeth are moved to the desired position, which is the final arrangement and the model setup is completed. Virtual set-up Simulated virtual treatment is formulated by proprietary 3-dimensional CAD-CAM technology. Clinicians then download the virtual treatment set-up to evaluate the proposed final positioning of the Dr Geoff Hall By Dr Geoffrey Hall Part 4 How to evaluate an aligner set up and ensure that the set-up is realistic Digital image by Direct Intra Oral Scanning Treatment plan
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