I. Introduction

  • Dr. Amanda from StraightSmile Solutions highlights one of Invisalign’s most underutilized features: the Bolton tab.
  • As far as she knows, no other aligner company offers this.
  • It’s a game-changer for diagnosing tooth size discrepancies even if you’re treating with braces.

II. Finding the Feature

  • On a desktop: top tabs, toward the right.
  • On iPad or smaller screens: hidden under sub-tabs. Find it.
  • Only works if the patient has all teeth 7-to-7, no missing teeth, no baby teeth, and no incomplete impressions.

III. The Numbers: 3-to-3 vs 6-to-6

  • Ignore the 3-to-3 number. It’s for anterior-only treatment (six-month smiles style).
  • Dr. Amanda doesn’t recommend anterior-only treatment because the results never look good.
  • Focus on the 6-to-6 number. Molar to molar. That’s the real story.

IV. Maxillary Excess vs Mandibular Excess

  • Maxillary excess: The top teeth are slightly bigger than they should be.
  • Result: Slight overjet. Canines stay Class I.
  • Option: Add upper IPR if the patient dislikes the overjet. Optional.
  • Mandibular excess: Bottom teeth are slightly bigger.
  • Result: Anterior collisions, edge-to-edge occlusion, and fremitus risk.
  • Action: Lower IPR is usually required. Not optional.

V. Treatment Thresholds

  • 0.2-0.3mm mandibular excess? Probably fine. Light occlusion, no big deal.
  • 1mm? Might offer IPR as an option.
  • 2-3mm? The patient will almost always choose IPR; it’s easy, fast, and fixes the bite.
  • 4mm+? Now we have a problem.

VI. Severe Bolton Discrepancies

  • 6mm mandibular excess? Can’t IPR that much.
  • Hours in the chair. Tooth sensitivity. Enamel loss. Unpredictable.
  • Options:
  • Veneers on 7-10 (or 7-10)
  • Extract a lower incisor
  • The magic number: Beyond 3-4mm, IPR isn’t the answer.

VII. A Critical Check: Verifying the Clincheck

  • Sometimes Invisalign screws up.
  • Example: 3.6mm maxillary excess, but Clincheck adds lower IPR.
  • Makes zero sense in a Class I patient.
  • Bolton tab catches these errors. You can push back and get it fixed.
  • Never fully trust a computer. Understand the why.

VIII. The Bottom Line

  • Use the Bolton tab on every Class I case.
  • It tells you if IPR is needed and where it’s needed.
  • Transfer that knowledge to your brace’s cases too.
  • Train your eyes over time, but until then, let the software guide you.
  • And always double-check. Computers make mistakes. You’re the doctor.