JDO 54 Special Topic

Introduction to Invisalign® Smart Technology:

Attachments Design, and Recall-Checks

Abstract
Modern clear aligners are engineered to expand the boundaries for the utilization of removable appliances to treat a wide variety of
malocclusions. Innovation is continually evolving to provide orthodontists with greater control of tooth movement to achieve desired
outcomes. Three current technologies are SmartTrack, SmartForce, and SmartStage. Attachment design is an important aspect of
ClinCheck. There are 5 questions that provide guide lines for choosing attachments. Two examples are presented to demonstrate
the design of dental attachments to facilitate tooth movement. Invisalign G6 is a method for treating patients with extractions,
particularly first premolars. It provides vertical and second order (root parallelism) control for predictable outcomes with maximum
or moderate anchorage. Efficient management of space closure is an important aspect for aligner therapy because enamel stripping
and extractions are common approaches for managing crowding and protrusion. At every appointment it is important to check
aligner adaptation (fit), attachment positions, and anchorage preparation. This article reviews clinical procedures for numerous
applications and also addresses clinical problems. (J Digital Orthod 2019;54:80-95)

Key words:
Invisalign clear aligners, ClinCheck software, SmartForce features, SmartTrack material, SmartStage, Attachment design, Invisalign
G6, Aligner fit, TADs, CII elastics

Introduction SmartTrack
Over the past 15 years Align Technology has SmartTrack is a materials innovation that evolved
invested heavily in clear aligner research and from 8 years of R&D investigating over 260 candidate
development ( R&D ) to expand the clinical scope materials with both biomechanics and materials
and predictability for management of a broad science expertise. 1 Modern aligner materials are
range of malocclusions in a global market of about composed of polyurethane derived from methylene
5 million patients. Innovations include SmartTrack, diphenyl diisocyanate and 1,6-hexanediol. This is a
SmartForce, and SmartStage (Fig. 1). From interdental medical grade polymer with supplemental additives
spacing to challenging Class III corrections, treatment to adjust material properties to produce a product
options are available for treating a large range of that is clear, strong, thin and flexible. In addition it is
malocclusions. hypo-allergic, inert and biologically stable.2 There are

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Dr. Ming-Jen Chang,

Lecturer, Beethoven Orthodontic Course, Taiwan
Editor, Journal of Digital Orthodontics (Upper left)
Dr. Chun Hung Chen,
Lecturer, Journal of Digital Orthodontics (Upper middle)
Dr. Chien-Yu Chang,
Lecturer, Journal of Digital Orthodontics (Upper right)
Dr. Joshua, Shih-Yung Lin,
Lecturer, Beethoven Orthodontic Course, Taiwan
Editor, Journal of Digital Orthodontics (Lower left)
Dr. Chris H. Chang,
Founder, Beethoven Orthodontic Center
Publisher, Journal of Digital Orthodontics (Lower middle)
Dr. W. Eugene Roberts,
Editor-in-chief, Journal of Digital Orthodontics (Lower right)

three different varieties: 1. LD30 (0.75mm) for Invisalign® aligners, 2. EX40 (1.02mm) for Vivera® and Invisalign®
retainers, and 3. EX15 (<0.75mm) for Invisalign® templates.

SmartTrack Features
1) Improved Control

Align Technology reports proprietary data from a pilot study of 1015 patients at 5 months follow-up.
Compared to the original aligner material, SmartTrack delivers optimal loads over the two-week period of
aligner wear designed to improve tracking and control of tooth movement. No data are presented but the
company claims the results were highly significant (p<0.001) at a 99.9% confidence level (Fig. 2).1

█ Fig. 1: The 3 innovations of Align Technology.

SmartTrack: Aligner material to supply gentle and content force.
SmartForce: Precise 3D control of tooth movement.
SmartStage: Optimizes the progression of tooth movement.

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JDO 54 Special Topic

curves, based on vitro measurements in a simulated

oral environment, appear to be consistent with the
conclusions, but Material Stress Relaxation is unclear
because stress is typically measured in Pascals not
Force. A more complete report or literature reference
to the actual data for Fig. 3 would be helpful.

3) Higher Elasticity
█ Fig. 2:
The percentage of patients remaining on track with Invisalign
treatment was significantly higher at a 5-month review SmartTrack aligners are composed of a more pliable
appointment (p< 0.001). See text for details. material (Fig. 3) that is more easily stretched over a
2) Improved Constant and Gentle Force dental arch, and less likely to crack (Fig. 4). The aligner
then returns more completely to its programmed
The applied force for the original aligner material
shape (memory). The decreased permanent distortion
decayed rapidly over the first few days of wear, but
illustrated helps facilitate precise tooth movement
decreased at a much slower rate for the last 10-
(Fig. 5). Reportedly the SmartTrack material is more
12d of the two-week period. In comparison the
comfortable to wear than previous aligners made
SmartTrack material delivered a lower initial load,
with the EX30 material.3
that decayed rapidly for the first couple of days and
then delivered a relatively constant load for the next
4) More Precise Aligner Fit
12d (Fig. 3).3 It is concluded that SmartTrack produces
a more constant and gentle load over the entire two The comparative fit (adaptation) of the more flexible
week period. Furthermore, there is a significantly material is tested with relatively opaque blue gel,
lower initial insertion load for each new aligner, that is added to the aligner before it is fitted on
which improves patient comfort. The comparative the arch. The overall less intense blue color of
SmartTrack indicates it conforms more closely to the
dental anatomy. Improved adaptation (Fig. 6) and the

█ Fig. 3:
Invisalign SmartTrack has a more constant and gentle force to █ Fig. 4:
achieve tooth movement. The standard aligner material requires a
The more elastic material is much less likely to crack when stretched
high insertion force and the load quickly decays over the two week
over a patients' teeth.
aligner wear period. See text for details.

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SmartForce
SmartForce was proposed for extrusion of teeth
in 2009. Later a beveled surface was added on the
occlusal surface of the attachment to enhance the
delivery of extrusive force ( Fig. 7 ).4 When a load is
transferred to the gingival surface of the attachment,
the bevel allows the tooth to move occlusally
( extrude ). Similar force vectors were developed
for attachments designed for rotational control,

█ Fig. 5:
When deformed, the highly elastic SmartTrack returns more closely
to the programmed aligner shape. See text for details.

tendency for less permanent distortion (Fig. 5) are

expected to translate into improved control of tooth
movement, particularly for finishing.4
█ Fig. 6:
Aligners are filled with blue gel and seated on a typodont. White
5) Enhanced Patient Comfort areas indicate direct aligner contact, and blue areas indicate a
gap between the aligner and the teeth. SmartTrack demonstrates
superior adaptation (fit), particularly in interproximal and
SmartTrack aligners are reportedly more comfortable attachment areas.
to wear and easier to take in and out, which is
an important feature if bonded attachments are
present. 5 Despite the improved performance,
the current aligners have good clarity, esthetics
and transparency, so they are an almost invisible
removable appliance.6 In addition, SmartTrack has
resulted in improved control of tooth movement, by
applying a more gentle and relatively constant force
( Fig. 3 ). These characteristics reportedly decrease
treatment time up to 50%, and tooth movement
is 75% more predictable7 because of the improved
█ Fig. 7:
conformity to the arch (Fig. 6) and less distortion (Fig. 5). Invisalign® proposed the concept of SmartForce in 2009. A gingival
rectangular beveled attachment was designed to extrude the tooth
efficiently.

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JDO 54 Special Topic

application of torque ( 3 rd order correction ), and

intrusion. The G4-G7 concepts were developed later.

SmartForce Features
To understand SmartForce capabilities, it is important
to carefully consider the attachment concept.
Depending on the design of the attachment relative
█ Fig. 8:
to the seating (full engagement) of an aligner, force
An attachment on an aligner is analogous to a handle on a
and couples to generate moments can be applied wardrobe or cabinet. The attachment (handle) provides retention
for an aligner.
to move teeth. In mechanics, a couple is two parallel
forces that are equal in magnitude, opposite in
direction (sense), and do not share a common line of
action. When the treatment plan calls for anything
other than tipping a tooth, an attachment( s ) are
necessary. It is essential to carefully evaluate the
couple generated by a loaded attachment, relative
to the force applied. The moment to force ratio (M:F) █ Fig. 9:
Three types of conventional attachments are shown. The ellipsoid
is directly related to the type of tooth movement: is seldom used now because of poor retention. The rectangular
tipping (low), translation (medium) and root torque attachment is effective for additional retention and can be used
to apply a couple (moment) to the teeth. The beveled attachment
(high). Another important consideration is the equal is still a good choice for extrusion although the newer optimized
attachments are now more common.
and opposite effect of the force system on the
anchorage unit. Bodily tooth movement (translation)
orthodontics. The G3 concept 5 for attachment-
and particularly root torque tax anchorage far more
mediated tooth movement was aimed at more
than tipping movements.
comprehensive applications such as rotations and
torque control.5,7 The principal difference for G3 was
Fundamentally, a surface attachment is much
power ridges6 built into the aligner, and a direction-
like a handle to move a sliding door (Fig. 8 ). Prior
oriented active surface on optimized attachments
to SmartForce, the principal attachments were
(Fig. 10).7 With the improved elasticity of SmartTrack
ellipsoid, rectangular, and rectangular beveled
(Fig. 3) a force applied to an active surface can be
( Fig. 9 ). Except for the latter, an aligner passively
used to effectively move a tooth in any direction.
fitting an attachment only provides retention. The
However, anchorage must be carefully considered
beveled attachments are worthwhile for aligning
particularly if the goal to move teeth bodily (translate).
the dentition to achieve limited orthodontic
There is a tendency to tip teeth with an active
correction, but they are not compatible with the
surface unless there is an adequate moment for
complex movement required for comprehensive
bodily movement. If it is desirable to retract a tooth,

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█ Fig. 10:
SmartForce is effective in two ways: 1. Built into the aligner, such as power ridges designed to control torque. 2. Active surface on an optimized
attachment to control tooth movement precisely.

such as a lower third molar, the active surface will

face mesially (Figs. 11, 12). The force developed to
bodily move any tooth must be carefully balanced
with an appropriate moment or the tooth will tip.
The type of tooth movement depends on the M:F
associated with the applied load.

There are many applications for SmartForce,

█ Fig. 11 :
depending on the design of the mechanics. The five In this stage, retraction (“distalization”) of LR8 (#17) is planned. The
shape of the #17 attachment on the aligner is a little different from
basic movements for a tooth are rotation, extrusion,
the one on the template. This configuration produces a force that
intrusion, torque control of the crown, and root pushes on the attachment of #17.
control. If multiple types of movement are desired,
there is a hierarchy for applicable attachments that
is based on the Invisalign data base. Every optimized
attachment comes with a set of rules based on the
longterm experience of the manufacturer. Doctors
can assess treatment progress, but changing
optimized attachments is not an option. However,
during a refinement (reboot) procedure, optimized
attachments can be replaced with conventional
█ Fig. 12:
ones if desired.8 The active surface on an optimized attachment produces a couple
that is designed as an anti-tip moment during space closure.

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JDO 54 Special Topic

SmartStage
In 2015, Invisalign released G6 along with SmartStage
to improve aligner performance for first premolar
extraction treatment.9 SmartStage is engineered to
optimize tooth movement progression, but it is an
abstract concept in mechanics that is challenging
for many clinicians. The first application is to modify
the shape of an aligner, and the other is to adjust
the sequence of tooth movement. Combining
SmartForce with SmartStage can enhance the
predictability of clinical outcomes. A careful
application of the method controls unwanted
tipping and anterior extrusion of incisors during
retraction.10

SmartStage Features
1) Optimaized Aligner Shape

Distal incisor tipping ( anterior torque loss ) and

buccal segment mesial tipping ( posterior torque
loss ) are common side effects when closing first
premolar extraction spaces.11 With fixed appliances,
clinicians can reduce these side effects with archwire
adjustments such as a curve of Spee adjustment,
gable bends or selecting a full-size rectangular
archwire.12 Clear aligners can simulate these effects
█ Fig. 13:
if they are designed to change form or modify in Aligner activation (Smar tStage) compliments optimized
shape. These aligner activations work together with attachments (SmartForce) to eliminate undesirable tipping
extrusion during retraction. Magenta curved arrows are tipping
optimized attachments to effectively close extraction moments when closing first premolar space. Red curved arrows are
space. These mechanics require precise engineering counter moments resulting from the aligner applying active force
on optimized attachments. Dark blue curved and straight arrows
to control both the moment to force ratio on each show the direction of root control in addition to preventing anterior
extrusion.
segment, and the equilibrium of the entire force
system (Fig. 13).

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2) Optimized Tooth Movement Sequence

SmartStage technology is designed to optimize

aligner shape and tooth movement progress to
achieve more predictable clinical outcomes. To
preserve posterior anchorage, a two-step anterior
retraction method is proposed instead of en-
mass space closure;13 however, this tends to be an
unattractive approach because it opens maxillary
anterior spaces. Aligners can utilize this approach
without an appreciable esthetic deficit because
aligner material fills the space during the retraction
process. Canines are retracted about 1/3 of the
extraction space and then all six anteriors are
retracted later, utilizing posterior arch anchorage
(Fig. 14).9 SmartStage adapted this modified two-step
anterior retraction process, although not all clinicians
accept this approach as effective and efficient.14,15
Mini-screw anchorage for en-mass retraction with
aligners is another option.

Attachments Design
Are attachments necessary to move teeth
with aligners?
Aligners can accomplish many types of tooth
movement without attachments because loads are
applied to the teeth by the surrounding material.
Tipping the crowns of teeth and incisor rotation
rarely require any attachments. Complex tooth █ Fig. 14:
SmartStage can be programmed to optimize tooth movement
movement and rotation of most teeth is difficult to sequence. Invisalign G6 is designed to retract canines first for about
accomplish without attachments. Attempting to 1/3 of the predicted space closure movement. The six-anteriors are
then retracted. This approach increases treatment time but may
correct major malocclusions without attachments is help preserve posterior anchorage. See text for details.

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JDO 54 Special Topic

likely to be frustrating for both the patient and the forces, but applying a significant moment to the
clinician. Attachment design is an important aspect crown of a tooth requires a couple, which depends
of diagnosis and treatment planning. on the active surface of an attachment. Optimized
or vertical attachments can translate teeth by
Tooth movement requiring attachments? increasing the moment to force ratio (M:F) of the

1) Rotation applied load. For pure translation, the M:F must

approximate the equivalent force system, meaning
Premolars have a small contact surface and relatively the moment must be adequate to simulate a force
round shape, so they usually require attachments for passing through the center of resistance of the
rotation (Fig. 15). root. An inadequate moment results in tipping of
a tooth while an excessive moment produces root
2) Extrusion movement without changing the relative position of

Aligners use other teeth as anchorage to develop the tooth.

extrusive force, but the mechanics are ineffective

unless the aligner has a firm attachment to the 4) Mesial Tooth Movement

surface of the crown to be extruded. It is very difficult Anterior translation of posterior teeth such as a
if not impossible to effectively extrude most teeth second molar is very difficult because the crown
without attachments. height is limited. Thus attachments are not effective
for generating a large moment. With aligners the
3) Translation mesial force on the molar must be relatively low to

Bodily movement (translation) requires a relatively avoid overcoming the limited moment generated

high moment to force ratio and substantial by the attachment to prevent tipping the molar

anchorage. Aligners are effective for delivering anteriorly. When substantial movement of molars is
required, aligners may not be the optimal approach.
Fixed appliance are much more effective in achieving
substantial mesial translation of molars.16

5) Intrusion

When intrusion is prescribed, attachments are

u n n e ce s s a ry b e ca u s e t h e a l i g n e r ca n ea sily
develop intrusive force. However, there may be
an undesirable extrusion of anchorage teeth.
Like translation of a tooth, intrusion can easily
█ Fig. 15: compromise anchorage because it is much easier to
Attachments are required for tooth rotation, extrusion, translation,
extrude a tooth than to intrude it. Attachments are
protraction (“mesialization”), and intrusion.

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usually required, for stabilization of anchorage teeth extrusion. Attachments are not required for incisors
into segments, to resist extrusion. intrusion ( Fig. 16 ), but the premolars serving as
anchorage, do require them (Fig. 17). The attachments
5 Questions for Attachments Design can be conventional (for retention) or optimized (for
extrusion and retention).
Clinicians are often confused by attachments.
There are 5 questions to help define and design
Molar-Intrusion Attachments
appropriate auxiliaries.
The intruded molars do not need any attachments
1. W h a t i s t h e p l a n n e d d i r e c t i o n o f t o o t h because the occlusal surfaces are adequate for
movement? Mesial, distal, extrusion or intrusion? delivering the axial load. However, the adjacent
premolars do need attachments to resist the
2. What is the function of the attachment?
Anchorage or delivering an active load?

3. Which is the active surface of an attachment? This

calculation is critical for estimating the amount of
force and the couple generated by programmed
recoil of the aligner. The M:F, plane of force
system, and underlying root structure dictate the
path of tooth movement. Like archwires, aligners
tie the arch together which is helpful for keeping
tooth movement under control as the active █ Fig. 16:
surface of attachments move individual teeth. The blue circle indicate there is adequate surface area on each tooth
for the aligner to apply the intrusive forces.

4. Is it feasible for an active load from an aligner

to produce the desired tooth movement? For
instance, severely crowded teeth may require
extraction, arch expansion and/or enamel
stripping to avoid undesirable lip protrusion.

5. Is the active force parallel to the direction of

tooth movement? If so, surface attachments are
a wise choice.

Deep-bite Attachments
█ Fig. 17:
The solutions for a deep-bite are upper incisor Attachments designed for managing deep-bite. The solid broad
arrow indicates intrusive force. The dotted arrow is the resulting
intrusion, lower incisor intrusion, or buccal segment (counter) extrusive force.

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JDO 54 Special Topic

resulting extrusive loads (Fig. 18). Again, attachments

on the premolars can be conventional for retention,
or optimized for extrusion and retention.

█ Fig. 18:
Attachments are designed for molar intrusion (solid broad arrows) █ Fig. 19:
and dotted arrows show the counter extrusive forces. These 3 key points allow us to monitor our treatment result
effectively at every appointment.
3 Key Points for Invisalign G6 Recall-Check
The Invisalign G6 is well designed to support first
premolar extraction cases. It combines the three
innovations of Smart Technology, to provide more
predictable and efficient root alignment. The
mechanics depend on carefully monitoring three
key points: 1. aligner adaptation (fit), 2. attachment
positions, and 3. anchorage preparation (Fig. 19).

Aligner Adaptation (Fit)

█ Fig. 20: Teeth are not fitting into the aligner (off-tracking).
Teeth not fitting well into an aligner is deemed
off-tracking, which is the most common problem
This is normal when the aligners are changed, but
with Invisalign aligners (Fig. 20). The first sign of off-
it should not be allowed to increase as an aligner
tracking is a gap between the aligner and the incisal
is worn. For example, the patient (Fig. 21) should be
edges or cusps of the teeth. This may occur for two
advised to bite on aligner chewies especially in the
reasons. The first is extrusion of anterior teeth was
off-tracked area. The second reason for off tracking
programmed into the aligner, or a canine is moving
may be that aligners are changed too frequently,
distally. Initially there will be a small space between
before the teeth have moved to the planned
the incisal edge or cusp of the tooth and the aligner.
position for the next stage of treatment. The patient

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 SmartTrack, Invisalign® JDO 54

may be trying to speed up treatment by changing Attachment Position

aligners at 7-day intervals or less. The most common G6 SmartForce features an Optimized Retraction
correction is for the patient to wear the problem Attachment that is designed to work with
aligner 3-5 days longer to determine if adaptation is SmartStage technology to achieve effective bodily
self-correcting (Fig. 22). movement during canine retraction. The multi-
tooth unit and staging of the G6 system is a complex
system that is not adjustable. It is an all or none
option (Figs. 23 and 24).

█ Fig. 23: The G6 features and biomechanics for space closure.

█ Fig. 21:
Patient was advised to bite on the “chewies” to seat the aligner into
an appropriate position for better adaptation.

█ Fig. 24:
In the Invisalign treatment sheet, the blue horizontal bar means
the multi-tooth unit that belongs to the same group and should be
maintained. The red notation indicates tooth movement desired
with aligner treatment.
█ Fig. 22: Aligner adaptation problems and the relative solutions.

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JDO 54 Special Topic

█ Fig. 25: Illustrations are shown for maximum anchorage and moderate anchorage in the G6 system.

The doctor's responsibility is to carefully check every supplemented with Class II elastics or temporary
attachment at each appointment. Any missing anchorage devices (TADs) (Fig. 26).
attachment must be replaced quickly with the
template supplied. A full compliment of attachments
is critical for space closure mechanics, so the patient Integrating Aligners and Fixed Appliances
is also asked to check the tooth surfaces with a finger Achieving precise tooth movement to resolve
every time they take out the aligner. If an attachment malocclusion is the primary goal for orthodontics.
is lost, an appointment with the doctor is required Aligner therapy is popular with patients, who do
within 7 days to repair the problem. not want to wear braces, but success with these
removable appliance is dependent on both the
Anchorage Preparation
The G6 system can be programmed with SmartStage
technology to provide maximum anchorage. Molar
stability is programmed to hold the A-P position
for achieving maximum retraction of the anterior
segment. Moderate posterior anchorage permits
<5mm of molar mesial movement (Fig. 25 ). These
anchorage options are programmed with the
ClinCheck system and must be carefully examined by
█ Fig. 26:
the doctor prior to approval. In order to accomplish
The intermaxillary elastics and TADs can be used as anchorage for a
an ideal result, anchorage preparation can be better treatment outcome.

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 SmartTrack, Invisalign® JDO 54

doctor and patient following instructions precisely. intelligence ( AI ), a type of technology based on
The principles for applied mechanics and anchorage massive data bases that is increasingly prevalent
are the same for all tooth movement, but the clinical in dentistry. Utilizing vast resources, Invisalign has
course for each approach is distinct. Both archwires developed 3 innovative technologies to expand the
17
and aligners are indeterminate mechanics so scope of aligner therapy and make patients more
periodontal ligament stress throughout the arch is comfortable during treatment.
unknown so the precise response to applied loads
are variable. The same risks apply to aligners and At the initial consult, patients should be encouraged
archwires: uncertain course of tooth movement, to share their chief complaint(s) so the doctor can
relatively long treatment times, and root resorption. properly diagnose the malocclusion, relative to the
patient's needs, and decide on a general treatment
The Insignia™ technology for fixed appliance plan. If a fixed appliance is selected, the mechanics
treatment was the first patent in orthodontics for are described in a straight-forward manner. On the
computer-aided design (CAD) and computer-aided other hand, an Invisalign consolation should focus
manufacturing (CAM). However, Align Technology on desirable outcomes and the necessity to follow
(Invisalign®) was the first company to actually market instructions precisely. The actual mechanics are
CAD/CAM appliances to move teeth. Invisalign has determined by technicians, utilizing automated
a long history of aligner innovations and clinical routines and attachments based on industrial
monitoring to improve outcomes. A trial and experience. The process is not intuitive so the doctor
error approach is appropriate for indeterminate and the patient are not going to understand it,
mechanics because the path and course for tooth but must accept the necessity to adhere to the
movement cannot be calculated. Most teeth do not instructions provided, to achieve a predictable
move precisely along the direction of the force, so clinical outcome. Some problems, mechanics, and
considerable R&D is required to define how teeth patients may be better suited to another CAD/CAM
will move in response to a given force system. The appliance, e.g. the Insignia™ system.
Invisalign team have monitored many outcomes to
define the treatment scenarios available to manage Aligner material is based on sophisticated polymer
complex malocclusions. Consequently, aligner science and progressive mechanics are a stepwise
therapy is less intuitive than fixed mechanics for iterative approach for applying loads directly
both the doctor and patient. The advice of Invisalign to teeth and/or via attachments. The greatest
technicians is based on algorithms developed with advantage for aligners is esthetics during treatment,
a massive data base which is the actual science but space management and protrusion can be a
of the mechanics. One can view the process for problem so enamel stripping and/or extractions are
sophisticated aligner treatment as a form of artificial often required. Fixed mechanics are based largely

93
JDO 54 Special Topic

on metals technology with an increasing emphasis uncertainty relative to planning treatment and
on long range superelastic loads. The latter has monitoring progress. The doctor must understand
substantial potential for controlling indeterminate that Invisalign® is a very sophisticated therapeutic
mechanics to decrease treatment time for a precise system that is not intuitive, so the aligners must be
correction of malocclusion. In addition, most severe applied as prescribed. If progress is disappointing,
skeletal problems can be conservatively managed it may be necessary to refine (reboot) the treatment
with determinate mechanics, that is anchored with process to achieve the desired outcome. Standard
17
extra-alveolar bone screw anchorage. It is clear that attachments can be changed at that time because
both CAD/CAM technologies (Invisalign and Insignia) a new series of aligners will be made. However, it is
are in the realm of a well-trained orthodontist. important for the clinician to refrain from changing
mechanics while a series of aligners is being worn.
In addition personalized treatment is rapidly The see it and fix it mentality that is common with
advancing, based on specific genetic and fixed appliances is inappropriate for complex aligner
18
environmental factors presented by the patient. treatment. Clinicians should practice and master the
Orthodontist of the future must evaluate the 3 check points as described in this article. The only
patient carefully to prescribe an appropriate periodic adjustments by the doctor are to replace
therapy. The preference of the patient will usually attachments, increase the time an aligner is worn, or
be the determining factor, because both CAD/ to insure that the teeth are well seated in the aligner
CAM approaches (aligners and fixed appliances) offer with chewie exercises. The doctor and the patient
excellent outcomes. The choice for the patient is must precisely follow instructions to benefit from the
esthetic treatment with aligners, but the treatment efficiency and precision of the prescribed treatment.
time will be substantial, and enamel stripping and/
or extractions are often required. The emerging
alternative with Insignia-SmartArch™ is relatively Acknowledgement
rapid, non-extraction treatment with braces. From Thanks to Dr. Rungsi Thavarungkul for the delicate
the patient's perspective, the outcomes will be original illustrations. Thanks to Mr. Paul Head for
similar. The treatment will largely depend on patient proof-reading this article.
preference: braces or not. A general dentist may only
be comfortable with aligners, but a specialist should
offer both options. References
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wires practice to offering clear aligners, there is

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www.invisalign-g6.com/en-GB/firstpremolarextraction.aspx
11. Grünheid T, Loh C, Larson BE. How accurate is Invisalign in
non-extraction cases? Are predicted tooth positions achieved?.
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