3Shape Clear Aligner Studio

Handbook
Creating clear aligners with 3Shape
 The 3Shape Clear Aligner
Contents Studio digital workflow
Scan...............................................................................................................................4
Design............................................................................................................................6
Print dental models....................................................................................................... 13
Prepare the models.......................................................................................................14 Scan Plan Design Produce
Thermoform.................................................................................................................14
Cut and finish the clear aligners ����������������������������������������������������������������������������������� 15

Clear aligners represent one of the fastest growing areas 1. Scan with an intraoral
or lab scanner
1. Occlusion setup
2. Model trimming
1. Place attachments
2. Subdivide setups
1. Print models from a 3D printer
(or outsource the production)
within dentistry. 3Shape’s digital workflow enables both labs 2. Sell treatment with 3. Segmentation 3. ID tag models 2. Thermoform clear aligners
4. Diagnostics 4. Export files for 3D print
and practices to enter this highly profitable market. the 3Shape TRIOS®
5. Create ideal setup
3. Cut, polish and finish
Treatment Simulator clear aligners
This handbook is a high-level guide for creating clear aligners,
from scanning with an intraoral or lab scanner to treatment planning, setup,
staging, and production preparation using 3Shape Clear Aligner Studio® Needed for scanning Needed for planning and designing Needed for producing
software, as well as the manufacturing of the models on 3D printers • 3Shape TRIOS intraoral scanner • 3Shape Clear Aligner Studio® (3rd party equipment)
and the thermoforming of clear aligners. • 3Shape Lab scanner • 3D Printer
• Thermoform machine
• Models wax
• Scissors / rotary cutting tools
• Polyrapid ‘sponge’
Note: this is a tool to help understand the steps in creating clear aligners
and will not provide any clinical guides for how to set up treatments or move teeth.

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 Scan
The 3Shape Clear Aligner Studio® CAD software requires a digital impression file to create
clear aligner models. Follow the 3Shape recommended scan strategy to ensure that
the digital impression file lives up to the following scan criteria:

1. Scan the full upper and lower jaw, with all teeth and molars included.
Even if only planning to treat one jaw, all teeth are still needed including
the antagonist and occlusion
2. Make sure to scan all incisal edges, occlusal surfaces and marginal ridges,
and avoid leaving any holes
3. Include the interproximal areas. This is important to have in case
any interproximal reductions (IPR) are needed
4. Include a minimum of 2-4 millimeters of gingiva from the gingival margin
to ensure that the thermoforming will fit the gingiva as well

Scan with a 3Shape Scan with a 3Shape TRIOS®

Lab Scanner Intraoral Scanner

Create the patient Send it to the patient browser

Mount the models or impression Choose a lab or in-house lab
into the lab scanner
Scan the teeth
Scan the models and the bite
Send the scan to the chosen lab
Trim or create the base
Send it to the patient browser

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 Design
The following three pictures show examples of these rules that are present as examples when
3Shape Clear Aligner Studio® is the all-in-one software solution for clear aligner the software is installed. Please note that all are examples, and should never be applied unless
analysis, setup and staging, and production preparation. the user makes the medical judgement that they are the right intended use for the given case:

1. Design your case in the Clear Aligner Workflow

• Create the virtual base (horse model) before the segmentation process so that Tooth Movement Constraint table
this only needs to be done once. This saves material during the 3D printing This example is for a simple
process and allows for higher accuracy during thermoforming treatment that doesn’t allow
movement of the molars
• Design the clear aligner treatment: perform the setup, staging and ID-tagging

2. Customize your workflow in the Control Panel

• Automatic attachment placing
• Movement constraints
• Report types

Step 1: Set up movement constraints in the Ortho Control Panel

Before the actual setup and staging of the clear aligners are initiated, it is possible to set up
various movement constraints that will enable the software to assist the user in making sure
various design guidelines are followed and are used for automatization of various aspects
of the design phase. Setting up movement constraints is not mandatory but Per-aligner Movement Constraints table
can be of great assistance. The most commonly used are: This example takes into account that not
all teeth are able to move/rotate the same
• Movement constraints for how much the various teeth distance per aligner
can be moved for the entirety of the clear aligner treatment
• Movement constraints for how much the various teeth
can be moved per aligner
• Which tooth movement will trigger an attachment, and which
tooth, and at what location and orientation on the tooth
• The above rules only need to be set up once, and then they
can be applied in the software whenever deemed relevant

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 Automatic Attachment Placement Step 3: 3Shape Clear Aligner Studio Workflow
Here is an example of an extrusion attachment.
Within the 3Shape Clear Aligner Studio® guided workflow, the user will
It will be placed with the center of the attachment
go through the following steps:
on the center of the crown (red dot on the right
coordinate system). Under ‘Movement condition
for automatic placement’ it is possible to see
that this attachment will be triggered if the tooth 1. Setting up planes
is extruded more than 0.3mm. Additionally
it will be automatically sized to take up 40% Various orientation planes are applied such as the occlusal plane
of the width, and 25% of the height and the sagittal plane. This will aid with orienting the models straight
of the crown (center column). just with the click of a button, and define the references for
various measurements.

2-3. Segmenting the upper and lower jaws

The segmentation divides the teeth into separate 3D objects
to enable individual tooth movements. The software will assist
the user in defining where individual teeth begin and end, and
how the gingiva contours are laid out. Long axis and rotation
Step 2: Preparing the models for the clear aligner treatment center are also defined.
1. Find the case in the patient browser
2. Create the horseshoe model before proceeding with
the 3Shape Clear Aligner Studio® workflow. 4. Defining the ideal arch
The user can define an ideal arch that will act as a design guideline
when the teeth are moved to the ideal setup. This step is not
mandatory and can be skipped if desired.

5. The virtual setup

This is the step where the user will design the clear aligner
treatment, using the following features:
• Setup
• Staging
• IPR
• Attachments
• ID-tagging

6. Creating the report

Create the report after finishing the case, this will give the complete
overview of stages, attachment placement and IPR. This is needed
to start the patient with their treatment.

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 Setup & Staging
The setup and staging are where the user will manually build the target ideal setup for the Once the setup is complete, then the software can aid in dividing the distance the teeth need to move
clear aligner treatment. When this step in the workflow is opened, the initial tooth position in sections that can be done by individual aligners. The settings that the user has set up for per-aligner
captured by the scanner will be displayed. To prevent overwriting this, which will often tooth movement constraints can be applied during this step:
be the malocclusion, the user needs to create a new setup where the teeth
can be moved into the intended position:

Once created, the user can now use

the various controls to move the teeth
into the intended position.

The software will then create the number of aligners needed to perform the designed/
In the lower left side of the screen, the movement constraints can be applied to teeth that are not moved programmed movements. The software can then be used to optionally determine
more than intended for the entire treatment (‘Teeth constraints’ option set in the 3Shape Ortho Control Panel). the placement of attachments based on the extent of those movements. Once selecting the teeth,
the software will apply the rules created in the Ortho Control Panel and a correspondent attachment
Crowding might be too severe to build the intended setup without having to apply interproximal reduction
will be placed. The attachments can be deleted or adjusted afterwards.
or extract teeth. That can also be simulated by clicking the relevant buttons in the center left part of the screen
next to the movement icon. A virtual articulator is available by clicking the icon found 5th from the bottom A setup and staging timeline chart showcases an overview view
in the right side of the screen which can help ensure that a functional bite is built. of the various tooth movements applied to each aligner.

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 Print dental models
Step 4: Export models This step can also be outsourced if the user does not have a 3D printer.
When the ideal setup has been completed, the corresponding models can be exported In the US it is required to use the 3D printer chosen in the design step – and follow
with automatically generated ID tags for easy identification later in the production process.
the instruction provided by the printer manufacturer to produce a dental model.
The outputted STL files can be saved at a location of the user’s choice
and are then ready to be used as part of the further production process.
Step 1: Job creation
With the completed model sequence, import them into a “slicing” software,
in which the software takes in the digital 3D geometry of the models and arranges
them on the build printer platformand outputs a job file, ready to be sent to the printer.

Step 2: Start the printer

Before starting the printer, a few things should be checked:
1. Make sure there is enough resin (there is a maximum marking on the back of the reservoir);
2. Make sure the build plate is clean and clear of debris from anterior prints.

Once this is done printing can be started. Select the desired layer height and being to print.
If the resin is cold, allow preheating to complete.

Step 3: Cleaning and curing

Once the printing has finished, follow the recommended steps:
1. Remove the build platform from the printer.
2. Once out of the printer, submerge the entire build in an ultra sound
IPA (2-propanol >75%) bath, and leave it for approximately 10 minutes.
3. Once the IPA and the ultrasound has done its job, take out the build
and use compressed air to blow off the remaining IPA.
4. Put the build plate (still with models on) into the UV curing box
and leave for approximately 15 minutes.
5. Once the curing is done, the models can be removed from the
build platform. The easiest way is to use a sharp metal scrapper,
wedge it under the models and force them off.

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 Prepare the models Cut and finish
After printing the models wax must be applied to control the following factors:
• Fit
the clear aligners
• Retention control/undercut removall
• Missing teeth or gaps
Step 1: Cutting and edge polishing
After thermoforming, the aligner is stuck inside a disk of material and must be cut free.
While cutting seems simple (it also can be) it still has big impact on patient comfort,

Thermoform meaning that care must be taken to do it properly. Both Scissors and rotary cutting
tools are used in aligner manufacturing.

• Scissors are by far the quickest, but they do put a strain on the hands
and clear aligners. They are also limited in the amount of detail
they can produce. If a scalloped cut is desired the only option
With the waxing job completed, the models are ready for thermoforming. is a rotary tool.
Place the model flat on the thermoformer. Most Machines offer a specific • Rotary tools do allow for finer detail and can also be used
base for 3d printed models, eliminating the need for messy pellets. for polishing the edge. The drawback is price, risk and speed.

Complete the thermoforming according to manufacturer guidelines.

In the US it is required to only use the 510(k) cleared material(s) Step 2: Edge polishing
Especially when rotary tools have been used, the edge often needs polishing.
stated in the 3Shape Ortho System manual. For this an array of tools is available to the dental technician.

Note: you might consider making a thinner tray for the attachment tray,
as this will make it easier to remove once the attachments are placed.
Step 3: The click
When the clear aligner has been cut and polished manually, there is a risk that
it may be deformed under handling. It should be checked by placing the aligner
on the model, and a correct snap fit will be confirmed by a click.

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About 3Shape
3Shape is changing dentistry together with dental professionals dental practices and labs. Two graduate students founded
across the world by developing innovations that provide 3Shape in Denmark’s capital in the year 2000. Today, 3Shape
superior dental care for patients. Our portfolio of 3D scanners employees serve customers in over 100 countries from 3Shape
and CAD/CAM software solutions for the dental industry offices around the world. 3Shape’s products and innovations
includes the multiple award-winning 3Shape TRIOS® intraoral continue to challenge traditional methods, enabling dental
scanner, the 3Shape X1® CBCT scanner, as well as market- professionals to treat more patients more effectively.
leading scanning and design software solutions for both

Let’s change dentistry together

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