Category Archives: Troubleshooting

Xyzal is a common “over the counter”(OTC) drug (antihistamine) used for allergy relief. Some animal studies have suggested that antihistamines, especially H1 blockers, can affect the osteoblastic/osteoclastic activity of bone remodeling resulting in an inhibiting of the tooth movement process, the degree of which is undetermined. With normal use as directed by the manufacturer and […]

Definition An incisal gap (large or small) is when there is a gap between the incisal edge of the tooth and the aligner. Incisal gaps are usually the first sign of a case going off track.   Causes Incisal gaps can be caused by any of the following: Patient is non-compliant and has not followed the recommended […]

Definition Rocking is when one side of the aligner first but the other does not. The side that is tracking will fit nicely (flushed), but the side that is tracking poorly will not want to sit at all. Trying to sit the aligner on either side yields the same results since the aligner will react […]

Definition An aligner is considered too big for the patient when it is obviously too wide or too long for the patient’s arch; there can also be difficulty with the aligner remaining in place while the patient speaks/opens their mouth. Too Big An aligner  is considered too small when it cannot easily be placed into […]

Definition Backtracking is when you have a patient wear the previous aligners longer than originally planned. Often, when the teeth have gone off track, they need additional time in a previous aligner/step to move fully into position. Backtracking gives the teeth the time that they need to get back on track with treatment. Uses Indicators for when backtracking may […]

Definition Bisphosphonates are a class of drugs that are used to treat osteoporosis and other diseases involving bone fragility and/or loss of bone mass. These drugs effect bone metabolism by inhibition of osteoclastic activity. The disruption of bone metabolism may have as small of an effect as slowing the rate of tooth movement during orthodontic treatment to […]

Overview The predictability and success of clear aligner treatment is dependent upon a number of factors: A proper diagnosis and treatment plan Optimal patient compliance (wearing aligners as directed) Diligent monitoring of the treatment progress by the doctor Knowing what to do when things don’t go as planned, a.k.a. “troubleshooting” Because there are variables that […]

Definition When there is not enough pressure on the teeth or tooth to get the desired movement needed in effort to align it’s position. See also insufficient space. Causes Most teeth will move with a little bit of consistent pressure on them. However, some types of teeth, some movement, and some other factors are more prone […]

Definition Insufficient space is when there is not enough room in the arch to align the teeth. For further information,  also refer to insufficient pressure. Causes When you prescribe your case, you can plan to create space with extraction, arch expansion, proclination or IPR, depending on how much space is required. However, despite prediction and planning, there may […]

Definition Maxillary Lateral Incisors have been proven to be specifically difficult with adult cases, most of the time its rotations, extrusion, and intrusions that laterals have issues with. Sometimes laterals can remain out of alignment even after revisions and despite compliance not being an issue, nor tight contacts. Causes The most significant challenge with maxillary lateral incisors […]