If you have been completing RPE, RME, and Schwartz Expander cases, it’s important to take steps to minimize revisions and refinement cases. Indeed, while you might notice great results with these cases initially, it’s quite possible to notice relapse once the expanders are removed.
But is this normal? How much relapse is normal, and should you over expand to account for this? We’ve outlined some of the key things you should know as follows to help you ascertain how to approach these cases.
How Much Relapse is Expected in Skeletal Expansions?
If you’ve completed RPE, RME, or Schwartz Expander cases before, you may have noticed revisions and refinement being needed after the case. This is due to relapse, but it’s important to understand what’s normal here.
If you’re completing these processes, taking things slow and steady can help reduce the amount of relapse your patients experience.
Now, there’s no set figure for how much relapse your patients will see. Most will experience between 10 and 20% relapse. However, relapse of 30% or more is potentially possible. This can be frustrating if you thought you’d completed the ortho treatment without needing revisions.
Should I Over-Expand to Prevent Revisions and Refinement Cases?
Generally speaking, you may want to over expand slightly to reduce the need for revisions and refinements. However, you should only go over carefully. Make sure you know when to stop expanding in time to prevent damage to the patient; for example, over-expanding could result in a Brody or Buckle crossbite.

Have you ever thought about using a GELB – otherwise known as a removable posterior bite plate? If this is something you have been considering, don’t worry; these handy tools are easy to integrate into your patient’s treatment plan when needed.
What Does a GELB Do?
At its simplest, a GELB helps to open up posterior bites. This makes removable posterior bite plates effective for scenarios where you need to jump a posterior crossbite or an anterior crossbite. They’re potentially ideal if you don’t want to resort to an acrylic posterior bite ramp or fixed posterior bite turbos.
Don’t Let Compliance Hold Your Patient Back
While a removable posterior bite plate can be highly effective for posterior or anterior crossbite cases, you need to make sure they’re open to wearing the bite plates first. Indeed, while many young children may consider it cool – it can come in any color of their choosing – it’s not uncommon for slightly older patients to be reluctant to wear it.
Naturally, the GELB needs to stay in 24/7 for it to work effectively. If the patient isn’t likely to go through with this, other options are probably better suited to your patient’s unique case. Be sure to discuss this with them before going ahead with the procedure!

As someone with experience as both an associate and owner in the field of orthodontics, you need to understand the owner’s perspective when it comes to Invisalign treatments. You need to remember that these treatments require a long-term commitment from patients, and compliance is key to their success.
As an owner doctor, it’s essential to ensure that your patients understand the expected length of treatment and potential additional fees if it takes longer than expected. To do this, consider setting up a compliance loop using paperwork and virtual monitoring for Invisalign cases. Remember that a successful Invisalign case is a marathon, not a sprint, and it’s important to communicate this clearly with your patients.
As a patient, attending your appointments on time is crucial for efficient treatment and avoiding additional fees. Consider using a monitoring system like In Hand Dental to stay on track and reduce the need for revisions and refinements. Set up an accountability loop before starting your treatment to ensure you stay committed to your appointments and improve your dental health.
If you’re an owner doctor, you might hesitate to offer Invisalign because of the billing structure. But don’t let this scare you away from providing this treatment option. Instead, use a production-based payment system that depends on the amount of production. This can make Invisalign treatment more profitable for you and your practice.
Use a 50/50 payment split, where 50% is paid at the start and 50% at the end, to prevent associates from leaving before completing the treatment they started. Also, have a written contract outlining what happens if an associate were to leave. This can help provide clarity and accountability in the payment process.
Conclusion
Both the associate and the practice need to have a clear understanding of the payment structure and expectations before entering into an agreement. The options for payment include a percentage of the fee charged, a flat fee per case, or a combination of both. Additionally, factors such as case difficulty, length of treatment, and the associate’s experience level can be considered when determining payment. Ultimately, a fair and transparent payment structure can help to ensure a successful and mutually beneficial partnership between the associate and the practice.

For the most part, bite ramps in Invisalign and other clear aligners are similar to bite ramps in braces. You will see bite ramps and bite turbos used in both methods of aligning teeth and correcting bites. Overall, the concepts are the same with both braces and aligners, but there are some differences.

The main goal of using these tools is to help take pressure off of the back teeth! So, let’s discuss some of those key differences between how you use bite turbos in braces versus clear Invisalign aligners.

In braces, they can be used to help patients who bite down or clench their teeth in order to help adjust the bite. While in aligners, this isn’t exactly a need due to the thickness of the plastic from the aligners. In this example, you would rarely or never use bite ramps to help with anterior or posterior crossbite in aligners.

While you do not need to help to jump the crossbite with bite ramps for aligners, they can still be used in some cases. In aligners, you can put anterior bite turbos to help prevent the intrusive effect of the plastic on the teeth. Using bite turbos in this way can help to prevent a posterior open bite due to the Invisalign. Because this isn’t an issue with braces, you won’t see bite ramps or bite turbos used in this way.

These differences come from the fundamental differences between braces and aligners. While braces are extrusive in nature, aligners are intrusive. Braces work better for lower-angle cases and deep bite cases, while aligners are better for high-angle cases. When using bite ramps in both aligners and braces, it is important to remember the differences between these two methods of correction.

Spark Clear Aligners: Are They Any Good?

When it comes to getting the best results from your dentist consultation, starting out with professional materials and equipment is critical. However, it’s not necessarily easy for many people to find the best custom aligners for your specific requirements. Luckily, as a leading dentist consultation team, we’ve outlined some of the key things you should know about Spark Clear Aligners as follows to help!

Spark Clear Aligners are a professional brand providing custom clear aligners for orthodontic procedures. The brand uses TruGen materials that can potentially provide even better transparency than regular Invisalign braces. However, are Spark Clear Aligners actually a good option for dentist consultation?

Are Spark Clear Aligners Any Good?

There’s a lot to love about Spark Clear Aligners. The brand does typically offer a good dashboard; however, turnaround times for custom aligner cases can be somewhat slow.

Many orthodontists have been finding that the wait times are often four days or more for each revision, and this can significantly slow the progress of cases. Comparatively, many other brands offer one-day delivery, which can be a more practical option for setting up and arranging treatment.

As such, if you have been looking for an effective custom aligners brand, Spark Clear Aligners may be a good option – but the slower delivery time can be a real problem for many people.

Discontinuing clients is a process! While you might know when to discontinue a braces client, you might still need to learn how to discontinue Invisalign clients for noncompliance. Poor oral hygiene, such as not brushing and flossing, is rare for Invisalign clients, but just because these cases are infrequent doesn’t mean we shouldn’t be prepared for them as providers.

Decay from wearing aligners while eating and drinking can be severe, and patients who continue to engage in this behavior are at risk of causing serious harm to themselves. Additionally, other circumstances with aligner noncompliance can be tricky.

So, can you discontinue these patients? Absolutely! Let’s go over how to enforce compliance and discontinue treatment if compliance standards are not met for Invisalign.


Informed consent is key in treating Invisalign patients, which should already be a standard part of your practice. This aspect of treatment includes clearly outlying how to care for aligners, when to wear them, and information on keeping up with oral hygiene. To enforce this information, many providers choose to use compliance contracts to allow them to move more clearly toward discontinuing treatment if patients are non-compliant.

If these measures are not working, and you have a patient who is damaging their teeth, you must communicate to them that the health of their teeth is more important than their alignment and bite. Explaining this to patients from an ethical point of view is the easiest, as patients have a basic understanding of the responsibility of providers to do no harm.

From here, as a provider, you would not move forward with giving this patient trays, offering them to take a break to work on their hygiene skills, or stopping treatment altogether. Sometimes, you may have to break up with the patient, but this decision will be in their best interest.

Discontinuing an orthodontic patient is a decision that should not be taken lightly. It requires careful consideration and planning to ensure the patient’s oral health is not negatively impacted.

Here are some steps to discontinue an orthodontic patient:

1. Discuss the decision: The orthodontist should discuss the decision to stop treatment with the patient or the patient’s legal guardian. The reason for discontinuing treatment should be explained, and any questions or concerns should be addressed.
2. Explain the consequences: The orthodontist should explain the potential consequences of discontinuing treatment, such as the possibility of teeth shifting back to their original positions, the risk of developing cavities or gum disease due to difficulty cleaning around the braces or aligners, or any other potential oral health concerns.
3. Create a plan: If the patient is discontinuing treatment because of financial concerns, the orthodontist may be able to work out a payment plan or other options to help the patient complete treatment. If the patient is discontinuing treatment for different reasons, the orthodontist may recommend a retainer or other device to help maintain the current position of the teeth.
4. Schedule a final appointment: Once a plan has been agreed upon, the orthodontist should schedule a final appointment to remove braces or other devices and discuss post-treatment care. The patient should be reminded of the importance of maintaining good oral hygiene and scheduling regular dental checkups.
5. Document the discontinuation: The orthodontist should document the decision to discontinue treatment in the patient’s record, including the reason for discontinuation, any discussions with the patient or guardian, and any agreed-upon plan for post-treatment care.
Wrapping Up
As a dentist, you must ensure your patients receive necessary care through informed consent and patient contracts. Once an orthodontic treatment plan is started, it’s important to ensure patients attend appointments and make efforts to reach them if they don’t. Discontinue treatment safely and responsibly after making every effort to reach the patient. Keeping up to date with dental practice laws is crucial to avoid legal consequences. Dentists are responsible for their patient’s teeth. They should maintain an active patient list and cross-check it with orthodontic cases to ensure patients receive necessary care while protecting themselves legally.

Have you ever wanted to find out more about the different processes available for fixing ERRS cases? You could take several possible strategies to fix ERRS cases, and using Invisalign and braces could be an excellent solution to help treat these cases. Why not try the following strategies, tips, and ideas – you might just find it’s a simple way to transform your ERRS treatment planning.
What is ERRS?
First of all, we should briefly mention what ERRS is. ERRS stands for “Extraction Retraction Regret SyndromeTM,” which is trademarked to the ever-talented Dr. William Hang. ERRS is a term used to define symptoms occurring due to permanent tooth loss, such as altered facial shape changes.
Fixing ERRS With Invisalign
Did you know ERRS cases can be tackled using Invisalign and braces? ERRS is commonly seen in cases where a patient has lost teeth, making the case seemingly impossible. This may be a complication of past orthodontic work that wasn’t necessary or was completed poorly.
ERRS cases are classed as interdisciplinary cases, so when using Invisalign and braces to fix an ERRS case, you should always work very closely with both a restorative dentist and a surgeon. Improper root placement can make the entire process harder; however, with a careful approach, completing the Invisalign work and restoring the teeth accurately is possible.
Fixing teeth with ERRS can take several years and cost significant money for restorative work. So, make sure you thoroughly cover every case in detail with the patient to ensure that you don’t face financial complications down the line.
Not Every ERRS Case is Necessarily Fixable
But don’t forget – it’s not always possible to reopen spaces in these cases. Indeed, after an extraction, it’s entirely possible for the bone to begin collapsing. This can further prevent restorative work from being completed for the patient. As such, it’s integral to explain this thoroughly to the patient when discussing whether such cases are possible to fix using Invisalign and other techniques.

Have you ever wondered about whether the Invisalign Express, Lite, and Go plans could be a good option for you and your clients? It’s not always easy to work out which Invisalign plan is right for you. After all, when we ask questions like, “is Invisalign right for everyone,” it’s important to consider that this will depend on the patient’s scenario overall. And, while Invisalign’s cheaper plans may be cheaper initially, they aren’t necessarily good value overall.

Ever wondered why some Invisalign plans don’t fit for every patient? There are numerous different factors that can influence this, and it’s critical that you consider how this could complicate your decision making process. With this in mind, one important factor you’ll need to address in your own Invisalign consulting cases is whether the cheaper plans – namely the Express, Lite, and Go plans – could be good value.

Now, if you had a really simple case, you could absolutely save money for your patient by using these plans. However, in most cases, this won’t be the case.

The beauty of the Invisalign plan is that it includes numerous refinements, and this helps provide amazing results! However, the Express, Lite, and Go plans are incredibly limited in the maximum number of aligners (a maximum of 10, 14, and 20 respectively). This could mean that your patient needs more aligners than the package includes.

As such, unless you have a relatively straightforward case, opting for the Moderate or Comprehensive Invisalign plan could be better value for money overall. Luckily, if you have any questions about this, our Invisalign consulting support can help you pick out the optimal plans for your own orthodontic consulting and treatment needs.

Final Thoughts

Invisalign can be an excellent tool for many clients, and as part of our Invisalign consulting services, we strongly recommend going for the Comprehensive plan overall. That’s not to say the Express, Lite, and Go plans are bad – but the patient may end up paying more in the long run if you choose these plans for additional revisions.

Case selection for aligners versus braces is highly dependent on the individual orthodontists. The answer to which type of treatment is best for which patient comes down to the skill of the orthodontists. Some orthodontists are so skilled with Invisalign that they can have the same exact outcomes for Invisalign patients who might have otherwise “needed” braces.

On the other hand, some doctors are better with braces than they are aligners. In this regard, it can be difficult to say which cases are better in Invisalign than braces, but let’s discuss some of the nuances!

While most of this determination depends on the orthodontist, it can also depend on patient preference. It may sound counterintuitive, but because orthodontists have varying skill levels, the onus is on the patient to decide what they want from an orthodontist. In this way, a patient can choose a confident orthodontist who specializes in Invisalign or a less confident orthodontist who may proceed hesitantly with Invisalign or sway them toward braces.

Asking for examples of cases is more powerful than designations like platinum or diamond providers. Another great question to ask your new orthodontist is to know what percentage of their cases are Invisalign versus braces. Additionally, being able to see your ClinCheck before you put any money down is a sign that your orthodontist is confident in their treatment plan for you.

Cases that can be easier in braces include impacted canines, really deep bite cases, crossbites, and anterior open bites. These cases are usually quicker in braces, but Invisalign can still be done with a short correction before aligners. As you can see, these cases are still 100% possible in Invisalign. They just might take longer than braces would.