If you’ve been working with a clear aligners company that allows proper sequential distalization, it’s worth noting that these cases will usually be quite time consuming, and you may end up doing one or two refinements, even if you take it slow and low and tackle things properly. But how should you handle refinements for these?
Tackling Refinements for Sequential Distalization
With a typical refinement, you’ll usually take a scan, a set of photos, get bite marks, take a panoramic x-ray, and so on. However, with a sequential distalization refinement, you’ll need to go a step further. In these cases, always map the spaces in the back of the teeth in addition to the usual checks.
To get an accurate measure, especially for open contacts, you’ll need to use an IPR gauge. Usually, gaps will be no larger than 0.5.
Include these in your progress notes or an IPR form; this allows you to cross reference with the ClinCheck to ensure the spaces are being picked up (especially smaller ones). If needed, you could potentially add ghost IPR to the next setup to make the treatment plan more accurate. This also allows you to demonstrate to the patient that yes, the treatment plan is progressing – even though they may not be able to see much change in the front of the teeth immediately.
Of course, before making any decisions on refinements and revisions for sequential distalization, always take a Ceph to check that the movements won’t cause adverse effects to the soft tissue and the bone.