acific Coast Society of Orthodontists Bulletin Summer 2018 - 57

Presentation Summary

Clear Aligner Therapy: Managing
ClinCheck - Macro to Micro
Dr. Christine Hong
PCSO Bulletin Columnist

Presented by Dr. Clark D. Colville at the PCSO
Annual Session, October 14, 2017
Dr. Clark Colville lectures extensively around the
U.S., primarily teaching orthodontic specialists
how to use Invisalign-branded clear aligners for
teenage and adult patients. (He was an
Invisalign-sponsored speaker.)

Dr. Clark D. Colville
Seguin and San Marcos, TX

He began his lecture by saying that there aren't a
lot of evidence-based papers about Invisalign
because the product is a rapidly developing
technology. During the time that it takes for a
research study to be published, a more advanced
ClinCheck software and treatment program
would probably already be updated and in use,
thus providing better solutions for tooth movement problems.
Dr. Colville said it's clear that the digital revolution is here. Current growth in Invisalign usage is
a direct result of orthodontic utilization; there
hasn't been any significant increase from the
general practitioner side in the North American
market, while orthodontists are showing doubledigit year-over-year growth in the use of
Invisalign-branded clear aligners.
Invisalign works well as a force system, said Dr.
Colville. The ideal goal is to have light, continuous
forces; plastic allows for the lightest force appliance (and changing over time). Clear aligners
deliver light intermittent forces, which may prevent root resorption.
Keys to Achieving Excellent Outcomes
Dr. Colville reported that to achieve the best outcomes, it's important to address each of the following: treatment planning, staging for effective
and efficient treatments, modifying ClinCheck,
attachment design, and finishing.
Treatment Planning
The first step is to look at the patient's clinical
exams, health history, and diagnostic records, and
then create a prioritized problem list and formu-

Summer 2018  PCSO Bulletin

late a solution for those problems. Next, create
an optimal treatment plan. This is where the
orthodontist determines the mechano-therapy
plan and the force systems for each patient.
Treatment planning points:

 Understand that teeth have to be moved in
three planes of space, so you have to learn
how to utilize the software programs to move
the teeth. Teeth should be adjusted based on
orthodontic tooth movement principles.
 Use the treatment plan as a guide for each
individual tooth.
 Move the teeth using 3-D controls to do the
ClinCheck; limit communication with the
techs to only the things that cannot be done
using 3-D controls provided in the software.
Remember, tooth movement guided by orthodontic principles provides efficient, effective, and
predictable results.
Staging Effective and Efficient Treatments
Staging treatment impacts overall office visits. It
is up to the orthodontist to decide how many
aligners to give to the patient at each visit, which
will determine the production per office visit.
It is preferable to change aligners weekly; this is
more comfortable, more hygienic, and more
enjoyable for the patient. Psychologically, changing aligners weekly rather than biweekly allows
the patient to feel that treatment is progressing
faster. In Dr. Colville's personal experience,
"Changing aligners weekly decreases total treatment time and improves patient compliance."
To determine how many aligners to use, here are
some questions to consider:

 How often do you want to see patients?
 How many aligners will you give per visit?
 Aligners should be ordered in multiples that
correspond to the number given at each visit.
 Overestimate; do not underestimate.
 Request the number of aligners at case submission and do not rely on software defaults.

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