As an orthodontist, a dental space pundit and the “mama” of the DTC aligner movement, I am often asked for tricks and tips for better aligner outcomes. I have to admit, I am blessed with a bit of a photographic memory. This came in handy on the D.A.T. perceptual ability section, but it also is gift in the prediction of orthodontic outcomes.

Long before A.I., us orthodontists used our own grey matter to predict outcomes. I’ve been in the field of orthodontics going on 18 years now, and I can honestly say that I’ve probably seen tens of thousands of orthodontic cases: my own patients, SmileDirectClub patients and my own StraightSmile Solutions’ client’s patients.

The following is a list of the ten best tips, tricks and pearls for ideal aligner outcomes:

1. Attachments aren’t required. There’s a billion-dollar DTC industry that has proven this concept. For most efficient outcomes and more complex cases, attachments are recommended, though.

2. IPR is very useful in cases of tooth-size discrepancies and perio patients. For me, any perio patient gets IPR. I don’t want to add to their attachment loss by pushing a tooth through the buccal plate. That is a lawsuit waiting to happen.

3. Trim is a personal preference. Don’t stress about it. Higher trim means better retention and less attachments needed but more fit issues.

4. Never, ever do single arch treatment. You’ll regret it. Just say “no”. Never, ever discount single arch treatment either if you do. It just takes once to learn why!

5. Always capture your terminal molar fully on your impression or scan. If it is erupted, you need to capture it. Trust me on this!

6. Your cases will track better and get done faster with a scan vs an impression. Stop stalling, just buy a scanner. It is worth the investment! We know companies that are financing for just $500 a month. If you are doing 1 case per month it is worth it and that is just aligners! Patient experience also has a value as well as shipping time, PVS costs and accuracy.

7. The most overlooked key to success is tracking. You can’t believe how many docs just give a handful of aligners to the patient and just roll the dice that the patients will track. I recommend for an affordable, HIPAA-compliant tracking option. Have the patients save all their old aligners. Invest $5 in a cheap, tackle box with compartments and label it for the patient and have the patients bring it to every appointment with their archived aligners sorted in their numbered spots. I have pictures of this hack on my YouTube site:

8. Less is more. Invisalign moves by default 0.25mm per aligner. ClearCorrect moves 0.3mm per aligner, but did you know that you can change that default if you do Invisalign Comprehensive or ClearCorrect Unlimited? One of the easiest hacks is to take their treatment plan, once optimized, and double it, thus making your increments smaller and more likely to track. If all goes well you can speed up the treatment plan with 4 day aligner changes for Invis and 7 day aligner changes for CC. You’ll look like a hero and you are still done at the same time! If your patient gets off track just go back to the archived aligners and with smaller incremental changes and less forces, you should never need a refinement! This hack is not at all popular with Align Technology or ClearCorrect Corporate, but my patients also get done quicker and use LESS aligners overall because they don’t often need revisions/refinements or MCCs!

9. IPR= more likelihood of refinements. Anytime you do IPR it isn’t an exact science so anticipate a MCC or refinement. Let the patient know. Check out our IPR webinar at to learn to do IPR more accurately.

10. Be on the lookout for masseters and low angle cases. I love intra-oral botox for aligner cases because those clenchers and low angle cases tend to get posterior openbites from all the intrusion. Be prepared: Use Invisalign only for these cases and add bite turbos preventively. It only takes one of these cases to learn your lesson! No, Align Technology won’t know your patient is a clencher so they won’t add them unless you ask for them. If you get a posterior openbite, don’t stress! One of the quickest way to eliminate them is an old-school positioner. Check out our webinar on closing iatrogenic, aligner openbites at

Orthodontic sleep, airway, tele-medicine and aligner companies are the hottest tech startups and StraightSmile Solutions® has the experience to to help you scale! We offer anyone currently in the dental industry a 20 minute complimentary consultation. Visit to schedule your phone call by clicking in the top, right corner.