So you have a Stubborn Tooth that's Not Moving in Invisalign or Clear Aligners?

So you have a Stubborn Tooth that's Not Moving in Invisalign or Clear Aligners?

Introduction

Dr. Amanda from StraightSmile Solutions introduces the ORC chart, simplifying orthodontic case analysis. It helps general, pediatric dentists and consumers, better understand clear aligner treatment by identifying and solving common issues:

What is the ORC Chart?

The ORC chart systematically diagnoses and troubleshoots clear aligner cases where a single tooth isn’t moving as expected. Unlike the Aligner Debond Chart, which assesses retention readiness, the ORC chart identifies root causes rather than increasing force.

Step 1: Assess the Treatment Plan

Before making any adjustments, it is crucial to review the initial treatment plan. This involves:

●????? Running a ClinCheck or similar digital setup to assess whether the case was planned correctly.

●????? Consulting an experienced orthodontist who is independent of aligner companies.

●????? Slowing down the treatment pace, as many plans are set to move teeth too quickly.

●????? Reviewing resources such as Dr. Amanda’s YouTube videos, specifically the “Double It Philosophy,” which explains the importance of slowing treatment progression.

Step 2: Check for Tracking Issues

Clear aligners depend on patient compliance. If a tooth is not moving as expected:

●????? Use virtual tracking tools such as Invisalign Virtual Care, Dental Monitoring, or InFace.

●????? Ensure patients are wearing aligners as instructed.

●????? Provide patients with proper take-home instructions, such as those outlined in the “2023 Clear Aligner Instructions” video.

●????? If compliance is an issue, address it before making other changes.

Step 3: Evaluate Bite Clearance

A tooth may fail to move if it is hitting another tooth or is impeded by occlusal interference. To check for this:

●????? Use articulating paper to identify any premature contacts.

●????? Consider minor adjustments, such as selective equilibration.

●????? If interference is confirmed, treatment planning may need to be revised.

Step 4: Assess Contact Points

Tight interproximal contacts can prevent movement. To resolve this:

●????? Check for tightness between teeth, especially in cases requiring rotation or extrusion.

●????? Use an IPR (Interproximal Reduction) strip or disc to create space.

●????? Continue monitoring contact tightness throughout treatment.

Step 5: Review Medications and Supplements

Certain medications and supplements can impact bone metabolism, affecting tooth movement. These include:

●????? Hormones (e.g., GLP-1 agonists)

●????? Bisphosphonates (used for osteoporosis)

●????? Herbal supplements with unknown effects on bone turnover

To determine if a patient’s medications might be affecting treatment:

●????? Cross-reference their medication list with orthodontic research.

●????? Use Google Scholar to find studies on specific drugs and their impact on orthodontic movement.

Step 6: Consider CBCT Imaging for Ankylosis

If all previous steps fail to identify the issue:

●????? Take a CBCT (Cone Beam Computed Tomography) scan of the affected area.

●????? Look for signs of partial or full ankylosis, where the tooth is fused to the bone.

●????? If ankylosis is present, alternative treatment strategies, such as moving adjacent teeth or restorative options, may be required.

Final Thoughts

If the issue persists after following all six steps, an expert consultation, like a session with Dr. Amanda, may help. The ORC chart provides a structured approach to resolving clear aligner cases for more predictable outcomes. For more details, case studies, and resources, visit Dr. Amanda’s coaching services at StraightSmile Solutions.