Role of Dentist/Orthodontist in Clear Aligners Treatment


Every Scientific field including medicine, as well as Orthodontics, is the continuous development and therefore subject to change. While few Orthodontic appliances/techniques became the indispensable part of Orthodontia, there are others who didn’t live up to the mark and were quickly forgotten. But the question is ” What is the role of a dentist/orthodontist in Clear Aligners Treatment?”.

Clear Aligner therapy is nothing new (as widely thought) but its roots date back to the too early 1920s when Remensnyder first used the technique. Later Kesling developed his POSITIONERS in the 1940s (which is to date used as Keslings SetUp technique in the fabrication of Manual Aligners). Several other contributions were done during the 1960s & ’70s but a real breakthrough came in 1993 when Sheridan invented his Essix System to treat a full case with the help of interproximal reduction. All these techniques were suitable to treat mild cases (a myth which to date persists- Clear Aligners are good for mild corrections only).

Role of Dentist/Orthodontist in Clear Aligners Treatment

In the late 1990s, the world of Clear aligners was to change (for good). For the first time, Computer designed software was incorporated in Orthodontia and first fully automatic clear aligners were manufactured. The initial few years were very turbulent as many cases failed and there loomed anxiety, will clear aligners therapy work? Is it good enough to be an alternative to braces? Well, the reasons for much of initial cases not delivering results up to the mark was very evident.

Suggested Blog: Aligners vs Braces

Role of Dentist/Orthodontist in Clear Aligners Treatment 2

There was not much knowledge within the dental fraternity about the appliance. This can be easily understood with a very simple example: When a driver is asked to drive an automatic transmission car from a manual hand gear machine, it won’t be easy for him/her as they are not used with the new technology. With time when they drive the automatic transmission car for some time and get used to it, it becomes easy and the ride gets smooth.

The technology was in infant stages. There was much work to be done on the software, which takes simulates tooth movement, to get accurate results

There was much training required for the software operators about what to expect when a certain malocclusion is presented. (On a software, on can do magical movements but the most difficult part is to anticipate how much a tooth will move when a specific malocclusion is presented. It should be noted that Clear aligners are customized appliances and almost every patient presents with different malocclusions as every patient has multiple variables on which tooth movement depends like Age, gender, race, medical conditions, dental conditions, etc.

The material from which clear aligners are made. (Every plastic is not the same. There are specific ingredients in the plastic which brings about specific movements. A lot of data is available on this topic on the internet).

The type of attachments used: This is a very interesting topic. Most people think that in clear aligners magic will happen. Just wear invisible plastic trays and teeth start moving the way they are shown in mock-up plans. But hold on! To move teeth the plastic needs to exert forces in specific directions to get accurate results. Without these customized attachments it is impossible. At least to date, with certainty. Certain companies claim that they have developed proprietary techniques to get results without attachments. Well, I am yet to see this happen. Only in very few minor movements of Incisors, this is virtually impossible and cases are either badly spoiled or keep getting refinements without an end.

When there are so many variables, how is it possible for someone to remotely treat a case without the involvement of a dentist to at least monitor the case? Who will place attachments? Who will report if anything is not going as planned? Who will do the procedures like interproximal reduction? Or who will decide which treatment plan is better for a particular patient?

I have always believed that appliances never treat the patients, doctors do. Appliances are just a tool that doctors use to get a result. When you are contemplating getting a treatment done without the involvement of a dentist directly by a company, throw another question at yourself to help you decide- will you board a flight that has no pilots and company claims that only autopilot will be enough to take you to the destination. Will you board that flight? If your answer is yes, then well you may well get your treatment done with machines & software with no one to guide and help you during the treatment.

by Dr. Swapnil Gupta (CEO, Directors ODS Aligners)