Orthotown September 2022 - 54

12 months, this requires commitment on their
part even if they get to a point where they
may " hit the wall " with aligner compliance.
Giving the patient accountability
We show patients various photos of trays
not seating on single teeth or groups of teeth
and I explain that some movements- especially
extrusive movements-can't happen
if a tray isn't gripping onto an attachment.
I further explain how if an attachment isn't
being gripped but the patient still moves
forward in the trays, they're actually adding
treatment time to their plan. If a patient
can't get a tray to grip an attachment after
wearing the tray for additional time or using
a chewie, I ask them to proactively make
an appointment.
We ask patients to self-monitor, and if
the appointment interval is longer than eight
weeks, we have a recall code that reminds
us they should email us a selfie photo with
their trays in. (You could also use a remote
patient monitoring system such as Grin.)
Asking the patient to send a photo and
self-monitor can increase patient accountability,
and I think directs them to pay more
attention to treatment.
Tips for discomfort
I recommend patients switch to their
next tray at nighttime before they go to sleep.
Sometimes the first few hours of a new tray
can be uncomfortable, and I believe it's nice
to get this period of time over while you
sleep. Every tip for decreasing discomfort
leads to a happier and more satisfied patient.
When using two materials-3M Flex
and 3M Force with 3M Clarity Aligners, for
example-there is a transition in which the
trays will feel different to the patient. I tell
them the 3M Force material feels tighter/
stiffer. It's important to educate them how the
54 SEPTEMBER 2022 // orthotown.com
different materials serve different purposes,
and thus they're entering a different stage
of treatment. Patients usually associate this
positively as progress!
Similarly, I explain that virtual space
closure happens at the end of treatment-there
are several overcorrection trays meant to close
any remaining space. If the patient's space has
already closed, I tell them sometimes the last
tray or two may feel too tight or they may not
even be able to get it on. This simply means
that their space closure is complete, and they
can stay on the last tray they can get on.
Motivating patients
* I pull up the 3M Oral Care Portal
and show patients their treatment
design at every appointment. This
seems to be very motivating and
helps patients understand what
changes to expect over the next
appointment interval. Sometimes
we email the treatment design to
patients so they can follow along
with treatment. Patients get amnesia
quickly! Halfway through treatment,
they forget what their teeth looked
like when they started. Show them
initial photos, or do a 3D scan
overlay showing initial and final
tooth positions, to get them excited
about their progress and feeling
thankful they made the decision to
correct their teeth with aligners.
* Tell patients about the fees for lost
aligners or switching to braces.
Even though we as orthodontists
are compassionate and love to give
things away for free, patients value
things they pay for. I believe in
being compassionate ... but also
in holding patients accountable for
their role in treatment success.
*
In complex cases that require
interproximal reduction, many
attachments and elastics, I try
not to overwhelm patients and
will delay starting elastics until
the second appointment.
* Practice placing and removing
aligners with the patient-give them
an aligner removal tool if needed
and tell them this gets easier with
practice. You'd be surprised how
many people panic when they have
trouble removing the tray the first
time they try!
* Do your best to keep your
word. Stick to your estimated
treatment time with efficient
treatment planning and effective
appointments.
*
Spend time adjusting staging and
making space, adding appropriate
attachments, and overcorrecting.
I love using a checklist!
* Use a UV light to check for flash
around attachments. Having
accurate attachments helps ensure
teeth track as planned.
* Floss contacts at every appointment,
and perform IPR as needed to ensure
predictable tooth movement.
Treat your patients like family
Our society craves connection. Many
people choose clear aligner treatment to
better their self-confidence, which in turn
improves their social connection. Make this
happen in the orthodontic clinic! Patients
trust kind people and people they have a
connection with.
Great doctor-patient communication
and a friendly orthodontic team will go a
long way toward creating a happy, trusting
patient. n
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Orthotown September 2022

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