Why Do You Always Need to Do Case Refinement?

Have you recently done a course in Orthodontics and are feeling anxious about implementing orthodontics into your practice?

Clear aligners are nearly invisible trays that correct malaligned teeth. When worn, the aligners embrace the teeth closely to bring about the desired movement. The fabrication of these aligners is done through an innovative technology by which orthodontic tooth movement can be “precisely calculated” and the entire journey with clear aligners can be mapped even before the patient commences with the treatment. Inspite of a comprehensive treatment plan and sophisticated technology, the results may not be as expected. This is when a case refinement is required.

What is case refinement?

Case refinement can be often referred to as fine tuning of orthodontic treatment performed with the help of clear aligners. A refinement period becomes the need of the hour when the teeth fail to reach their ideal positions during the latter stage of the treatment. Hence, this final detailing phase is often incorporated in the refinement phase of treatment to deliver the best possible outcome.

How to understand if case refinement is needed or not?

As a dental practitioner, you plan the clear aligner journey for your patient meticulously by utilising your expertise and work on every minute detail of the treatment like the number of aligners needed, the timing, the staging of movements, the type,  position and size of the attachments (if any) and so on.  You try to explain to your patient about what is to be expected in the entire clear aligner journey. Then, there comes an instance, when just 20% of the journey is remaining, your patient turns up saying the aligners don’t fit as snuggly as they used to any more, or there is a visible space or a large gap. This might point out the fact that a case refinement is necessary.

In some cases, you may observe that the patients show a definite time lag in achieving their predetermined teeth movement milestones. Such a case may demand a refinement period in future.

The duration of the refinement period may differ from one case to another.

The teeth failing to move in an expected manner could be due mostly to inevitable individual variations. Another common reason is noncompliance of the patients. Clear aligners are to be worn for a period of 22 hours a day. When patients fail to maintain the recommended wear time, they become more prone to case refinement. Close monitoring of the case is essential to understand if the final position of the teeth matches what was planned in the beginning of the treatment. If not, fresh impressions or digital scans need to be obtained and a new set of aligners need to be prepared based on the new 3D digital scan. As a clinician, it is important for you to explain the possibility of case refinement to your patients prior to the commencement of  treatment as case refinement at the final phase of treatment can be upsetting for both the clinician and the patient.

It has been my clinical experience that many of these issues that have required case refinement are due to a poor initial plan- hence the correct plan may counteract many of those previous issues. The correct plan requires extensive knowledge of aligner biomechanics, the correct staging of movements, the type, position and size of the attachment for various movements, the overcorrections required for different objectives and a realistic understanding of movements that can be achieved. This requires excellent knowledge as a result of loads of training and learning.

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