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), and 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 between the jaws in the sagittal and vertical planes and the inclination of the teeth in the basal bone. In addition, 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 teeth' coronal and radicular movements can be considered.

2. After performing these preliminary procedures, the orthodontist will diagnose 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. With the help of these splints, 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 sling.

4. The total number of aligners will vary depending on the malocclusion's complexity and the orthodontist's treatment plan. Factors such as periodontal status or root length are precise determinants of a more significant 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 their teeth. The professional will indicate the guidelines for changing the splints 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 proper adjustments in each phase of the treatment.

7. Visits to the dental office for follow-up will be established between 30 and 45 days and according to the phases of treatment.

8. The indiscriminate use of these splints, without programmed supervision by a qualified professional, can create dental, occlusal, and functional problems for the patient. Patient follow-up is no longer 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, lips, etc.), sensitivity, sores, occasional discomfort in some teeth, etc. In addition, the continuous rubbing of the appliance can have consequences on mucous membranes and soft tissues. Therefore, it is necessary to follow up in person, paying particular 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, determine the corresponding legal responsibilities.