acific Coast Society of Orthodontists Bulletin Summer 2018 - 58

Presentation Summary

For example, Dr. Colville sees his patients every 10
weeks and gives 10 aligners, so he only orders
aligners in groups of 10.
Dr. Colville provided these initial staging guidelines:
 20 aligners: Minor crowding, minor root
movement, minimal interproximal reduction
(IPR), no elastics
 30 or 40 aligners: Moderate crowding, root
movement, elastics, sagittal changes, moderate leveling
 50 aligners: Maximum crowding, maximum
IPR, root translation, severe rotation, deep
curve of Spee

ClinCheck: Macro to Micro
Dr. Colville provided some general ClinCheck
principles. He said it is important to follow the
treatment plan for each tooth movement. Keep
it realistic; don't put anything in ClinCheck that
is not in line with what you would expect to see
with fixed appliances. Do not use the surgical
shift to simulate sagittal correction if you're not
doing surgery. With IPR/Bolton analysis, strategic
IPR makes the teeth fit well in most treatment
plans. Remember to maximize the aesthetics -
consider the incisal display and the smile arch
along with individual tooth shape. And remember, ClinCheck is a two-arch adjustment; each
arch is independently modified according to
treatment goals for that specific arch.
The ClinCheck Modification Process
Macro movements are completed in this order:
first, transverse movements (root movement,
arch form, expansion); second, sagittal movements
(crown angulation); and finally, the vertical movements (arch leveling, esthetics, occlusion).
Micro movements involve minor changes in rotation (embrasures, ideal+); crown adjustment
(buccal/lingual for arch form - central grooves -
cusp tips); and minor mesial-distal correction.
Mesial-distal correction may be the first thing
done in ClinCheck, but in 90% of Class I molar
cases, it goes from macro to micro. This order was

created to provide a consistent workflow and to
complete everything in one modification.
Attachment Design
For ideal attachment design, evaluate each individual tooth using the tooth movement chart,
and assess the direction and magnitude of all
values. Select the attachment that matches the
treatment priority - remember, the first series
of aligners will focus on leveling and rotation
correction. Additional aligners focus on root
alignment. Determine whether an optimized
attachment feature can be placed and whether
non-optimized attachments are necessary.
The only communication required with technicians should be to request specific optimized
attachments.
At this point, Dr. Colville presented a patient case
to the attendees and went through each step of
the ClinCheck modification process as described
above.
ClinCheck modification:
1. First step: Root apex (transverse root alignment and arch form) alignment
2. Second step: Crown angulation (sagittal root
alignment within the arch)
3. Third step: Vertical alignment (arch leveling,
overbite, occlusal contacts)
4. Fourth step: Rotation (micro adjustments
from here on out)
5. Fifth step: Crown tip buccal lingual
6. Mesial-distal movement: The first step or the
last step
7. Mandibular arch: Repeat the same steps and
match the maxillary arch.
Dr. Clark Colville currently serves on Align Technology's Clinical Advisory Board (now known as the
Global Scientific Advisory Board) and is a regular
speaker for the company. He is also the co-founder,
together with Dr. Dave Paquette, of Smile Assist
LLC, a 3-D consulting and digital treatment planning service. He holds a similar position with
Henry Schein Orthodontics as a member of their
Inner Circle. 
PCSO Bulletin  Summer 2018

Table of Contents for the Digital Edition of acific Coast Society of Orthodontists Bulletin Summer 2018