GAP Magazine Clear Idea Volume 5

6 www.acasociety.com | info@acasociety.com A s many of our members know by now, the concept of aligners dates back to Dr Kesling’s “tooth positioner” appliance in the 1945. Later on, we saw the rise of the “Essix” appliance, invented by orthodontist Dr Sheridan, which also used thermoplastic suckdowns to do minor anterior movements. In fact, the term “Essix” is an acronym for “S-Six” which stands for Sheridan’s Simple System for Stabilising the Social Six. Thermoplastic retainers also grew in popularity during this time. What a lot of these appliances had in common is that, although a snug fit, with enough dexterity and repetition, removal was very rarely an issue. Similarly, Invisalign ® aligners in the “early” days (circa 1999-2004), were in the same category. But then a change happened – as engineers and clinicians continued to develop what can and can’t be achieved with aligners, the industry began to see the evolution of attachments (also known as engagers, buttons etc). We are all still learning exactly what attachments do (or don’t do), what their optimal shapes and sizes are for particular movements and how many we should put. What we do know for sure is that the addition of (the correct) attachments in general has been shown to increase the range of movements and difficulty of cases that can be treated using aligners. As such, we are absolutely seeing an increase in the number of clinicians and technicians using multiple attachments. And with that, a problem (and solution) was born. As more and more attachments were used (particularly rectangular conventional attachments), patients found it increasingly difficult to remove aligners with their fingers – many often commenting that they “feel stuck”. Some patients found it difficult due to dexterity, some found it difficult due to brittle or fragile fingernails and some didn’t like the feeling of putting their fingers in their mouth. The latter has particularly increasedduring theCOVID-19 pandemic. So, with all that noted, the following is a discussion surrounding tools the industry has developed to aid patients in removing their aligners. Please note, although I aim to cover the main types I know of and have used for my patients, this is not an exhaustive list and welcome anyone who has alternative tools to share it with me via email (members@ acasociety.com) . Product Review: Aligner removal tools A review – Dr George Abdelmalek Outie tool The Outie tool is one of the original remover tools, and was designed in America by a registered nurse. It has a 2 in 1 hook and lever system. The hook and lever glide in easily and is effective in removing aligners. One hook is for the uppers and lever is for the lowers. Their website claims to have sold over 4.5 million “Outies” so its popularity is clear. Although quite an easy tool to use, the main issue I have with it is that it doesn’t fit into your standard aligner carry container. As such, it becomes another thing that patients need to carry around. For some, especially those who carry around a whole kit (eg toothbrush, floss etc) this isn’t an issue. But for those who only want to carry around a case, it is a big hindrance. Pultool The Pultool was developed by an American dental assistant. It is a completely different shape to the Outie tool in that only it comes with one hook (parallel to the shank) that is intended to be used for upper and lower. The other side of the tool is a finger ring that is used to help pull from. Of course, the main advantage of this is the tool is considerably shorter, meaning it fit well into most aligner carry cases. The hook is well designed in that it is rounded off so to be particularly gentle on gums. It comes in a range of colours and another advantage is that the company has developed an aligner seater that can be incorporated in the remover tool to further aid in minimising the need for patients to put their fingers in their mouth for both removal and seating. The Ortho key One of the original aligner removers in this shape, the Ortho key is particularly popular in USA. The hook is perpendicular to the shank. Like the Pultool, it has one removal side and the other side being a finger ring for grip. Similarly, it is a compact size allows it to fit into most aligner carry cases. It is also made with food-grade BPA free plastic.