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Protocol for the use of clear aligners.

 The patient should undergo a routine orthodontic examination before treatment.

Protocol for the use of clear aligners

Given the increase in companies that advertise and market dental aligners online, using unorthodox methods that have an impact on the oral health of citizens, we share a protocol for the use of clear aligners. 

Because of its interest and importance for professionals and patients, we summarize 10 points on which this protocol is based:

1. The patient should undergo a routine orthodontic examination before treatment, which should include an exhaustive analysis of the clinical history (anamnesis), intraoral, functional, and extraoral oral examination, which should consider both general dental aspects and specifically orthodontic aspects. Intraoral and extraoral photographs should also be taken, as well as a complete radiographic examination. A lateral teleradiography of the skull is also recommended to assess the relationship of the jaws in the sagittal and vertical planes, as well as the inclination of the teeth in the basal bone. Silicone or intraoral scan impressions of the arches should be taken. Other complementary explorations should be evaluated according to the previous findings that the specialist considers necessary. Finally, it is considered very useful in all adult patients to take an intraoral scan and a CBCT so that, when making the 3D orthodontic diagnosis, the coronal and radicular movements of the teeth can be taken into consideration.

2. After performing these preliminary procedures, the orthodontist will make an accurate diagnosis of the patient's malocclusion and draw up a treatment plan to correct the malocclusion.

3. Using advanced technologies, a series of custom-made transparent splints will be programmed sequentially, and with the help of these splints, which are prepared using a specialized program that allows visualization of the dental movements programmed by the professional, the teeth will move progressively with the change of each splint.

4. The total number of aligners will vary about the complexity of the malocclusion and the orthodontist's treatment plan. Factors such as periodontal status or root length are clear determinants of a greater number of aligners for the same movement.

5. They should be worn continuously for 20-22 hours. They should be removed for meals and brushing the teeth. The guidelines for changing the splints will be indicated by the professional, at intervals of 7, 10, 15, or more days depending on the periodontal condition, the difficulty and degree of movement, the technique and materials used, the prescription, and the phases of the treatment.

6. The placement of the splints should be carried out in the dental office and the professional should be the one to give the appropriate indications to the patient and to check and verify progressively that the program is being carried out, and thus be able to make the appropriate adjustments in each phase of the treatment.
7. Visits to the dental office for follow-up will be in a period established between 30 and 45 days and according to the phases of treatment.

8. The indiscriminate use of these splints, without programmed supervision by the qualified professional, can create dental, occlusal, and functional problems for the patient. Patient follow-up is in no way restricted to the evolution of dental alignment with the aligners and should include early diagnosis by probing for new caries, inflammation, and gingival recession.

9. Therapy with transparent aligners can present certain complications and risks: irritation of the soft tissues (cheeks, tongue, and lips, etc.), sensitivity, sores, occasional discomfort in some teeth, etc. The continuous rubbing of the appliance can have consequences on mucous membranes and soft tissues, and therefore, it is necessary to follow up in person, paying special attention to the appearance of traumatic or premalignant lesions.

10. At the end of the treatment, as in any type of conventional orthodontic treatment, fixed and/or removable retainers will be placed and new follow-up appointments are essential to check the stability of the treatment and the dental, gingival, mucosal, and osseous condition of the patient, as well as that of the retainers themselves.

Once the treatment is completed, new records (photographs, models, and radiographs) should be taken to rule out the appearance of complications and, if necessary, to determine the corresponding legal responsibilities.

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