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Clear Aligner Hiccups: We've all been there!

Have you ever felt like you're the only one facing challenges with clear aligners? Think again!

Clear aligner treatments have revolutionized orthodontics, offering a more aesthetic and user-friendly alternative to traditional braces. However, like any medical procedure, they come with their own set of challenges. In this blog, we'll explore some common issues you may encounter and how to navigate them effectively. The key isn't to find a one-size-fits-all solution but to understand the underlying principles that guide successful treatment. 

It's all too common in the world of clear aligner treatments to hear practitioners blaming the plastic when things don't go as planned. But let's put an end to this misplaced blame! When challenges arise in cases involving fixed appliances like braces, you never hear anyone faulting the metal. Why? Because we recognize that these materials are merely tools in the hands of skilled professionals. The obligation is on us, the dental experts, to understand the mechanics and principles that make these tools effective. Instead of pointing fingers at the plastic, let's concentrate on refining our skills and knowledge to ensure that we're using these revolutionary tools to their fullest potential.

The Importance of Accurate Diagnosis 

Before we delve into the challenges, it's crucial to emphasize the role of accurate diagnosis and treatment planning. A well-thought-out treatment plan is your first line of defence against potential issues. This is where programs like our MOCA 101 program shine, offering a comprehensive understanding of diagnostic and treatment planning.

Common Challenges and How to Navigate Them

Tracking Issues

Problem: The aligners are not fitting well, and the teeth are not moving as planned.

Solution: Re-evaluate the treatment plan and consider rescanning the patient. It might also be helpful to look into IPR (Interproximal Reduction) or adding attachments for better grip.

To move teeth effectively, you need three ingredients: force, time, and space. While force and time are largely dependent on patient compliance, space is where you have control. Remember that friction is the enemy and can prevent tooth movement.

Non-tracking teeth are often a result of patients not wearing their aligners. How can you tell?

  1. Ask the Patient: If you have a good relationship with your patients, they will be honest with you. Our "Delivery and Follow-Up" online course offers a comprehensive checklist to guide you through what to ask and check during each follow-up appointment.
  2. Examine the Aligners: Is the misfit a general issue, or is it localized to one or a few teeth? For instance, if only the upper laterals are not tracking, but everything else is, the issue likely lies in the treatment plan, not in patient compliance.

Example of a POB solved by passive eruption

Posterior Open Bites (POB) 

Problem: The patient is experiencing posterior open bites, commonly believed to be caused by the intrusion of posterior teeth due to the thickness of the aligners. The first thing to ask yourself is: where does the problem come from? Is it an anterior or a posterior problem? Or a combination of both? 

Solution: Often, the underlying cause of posterior open bites is anterior interferences, challenging the common assumption. These interferences can arise from several factors:

  1. Treatment Planning Issues: If the virtual setup or ClinCheck displays an insufficient overjet (OJ), it could be a sign of incorrect treatment planning.
  2. Failed Intrusion: The lower anteriors might not have intruded as expected, possibly due to inadequate staging or anchorage.

Moreover, if you've planned for significant expansion in your treatment, it could be another culprit for POB. Here's why: In the virtual setup, teeth appear to translate perfectly, but in the real world, they don't always follow suit. This discrepancy can lead to molars and premolars flaring because of forces acting on the palatal surface. Since these forces don't align with the tooth's center of resistance, they generate a moment, causing the tooth to rotate rather than translate.

This is where our course on "Basic Tooth Movement Mechanics" becomes invaluable. The world of clear aligners revolves around mechanics. By understanding these principles, you can pinpoint why teeth aren't moving as anticipated. Always bear in mind: teeth don't "see" the ClinCheck; they respond to the mechanics!

Discomfort and Pain

Problem: The patient is experiencing discomfort or pain during the treatment.

Solution: While some discomfort is normal, excessive pain is not. Reassess the fit of the aligners and the rate of tooth movement. Slowing down the treatment might be necessary. If the patient complains about pain due to elastic hooks, advise them to wear the elastics. 😉 If they feel the attachments, remind them to wear the aligners!

Speech Issues 

Problem: The patient is having difficulty speaking clearly with the aligners.

Solution: This is usually a temporary issue that resolves as the patient gets used to the aligners. However, if the problem persists, it may be necessary to adjust the aligner's fit. Bite ramps, if you use them, could be a reason causing speech issues.

The Role of Continuous Education

The field of clear aligner treatments is ever-evolving, and staying updated is crucial for successful outcomes. One of the most significant advancements in the field is the understanding of the importance of staging movements like distalization, intrusion, and expansion. Properly staging these movements, where some teeth serve as anchorage or resistance while others move, results in more predictable outcomes, less frustration, and ultimately, a more efficient treatment timeline. Even if it means using a few more aligners initially, the overall treatment time is often reduced.

To delve deeper into the principles and mechanics of tooth movement with clear aligners, our online courses and programs offer comprehensive knowledge. We'll make you think like plastic, understanding the nuances of how clear aligners work, making your treatments more predictable and successful. 


Navigating the complexities of clear aligner treatments isn't about avoiding challenges; it's about embracing them as avenues for learning and professional development. Armed with the right expertise, you can turn these challenges into stepping stones for better patient outcomes. Continuous learning is your ticket to staying at the forefront of this dynamic field. As the saying goes, theory is a great starting point, but there comes a time when you've got to dive in and put your hands in saliva!

Reflecting on your past cases, scrutinizing your planning strategies, and understanding what worked and what didn't, enriches your practical experience. It's this cycle of doing, reflecting, and learning that takes the principles and insights gained from your courses and transforms them into real-world expertise.

Interested in mastering the art of navigating challenges in clear aligner treatments? Our M.O.C.A. programs (Master Of Clear Aligners) offer a comprehensive education, from the basics to advanced techniques. Because at The CLEAR Institute, we believe in empowering you to offer the best to your patients.

Have fun learning, have fun troubleshooting your cases, and, as always, have fun Making the MOVE!


You want to know more about how to Troubleshoot your clear aligner cases? Register for our online course "Troubleshooting 101" HERE 

Troubleshooting 101

Register for our courses today and embark on a transformative learning journey with The CLEAR Institute.

You want information on our courses, programs, and services? Book some private time with Dr. Stephane Reinhardt HERE

You need help with your cases, and you want personalized one-on-one private coaching? Book some private time with Dr. Stephane Reinhardt HERE

To learn more about our online and in-person training, here are the direct links:

✅     Online courses:

✅     LIVE In-person classes:

✅     MOCA programs (Master Of Clear Aligners):

✅     YouTube channel:

✅     Ebook 10 tips and tricks to use with clear aligners:
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