Whether pursuing the perfect selfie or chasing airbrushed images presented by the media, many adults seek a better smile. As orthodontists, we enjoy the opportunity to help. Correcting our patients’ teeth can do more than improve their smile; it can also help bite function and overall dental health.

Patients seem to be requesting clear aligner treatment more. Although there may be many benefits to clear aligners for patients, there can be several drawbacks for orthodontists. How can we minimize the pitfalls and protect ourselves against negative claims?

1. Evaluate—As we know, many patients appreciate that aligners are clear and more discreet than wires and brackets. Nevertheless, these aligners are not always the best choice for straightening teeth. It’s important to evaluate each patient’s orthodontic records to see if there are potential problems in choosing aligners to treat the case. Consider extreme crowding, crossbites, anterior open bites, missing teeth, periodontal and bone issues, implants, medications, and more. The patient seeks your expertise, and it’s important to explain any possible problems—and solutions—even if it means providing other alternatives.
2. Educate—Many patients are already sold on the idea of clear aligner treatment before they come to your office. Due to the popularity of Invisalign® and other clear aligners, as well as the spread of the do-it-yourself (DIY) market, they may be convinced it’s their best choice for an improved appearance. As an experienced professional, however, your role in educating them and addressing the potential risks and benefits of all types of treatment is critical.
3. Advocate—Address whether clear aligners are truly the best option for their circumstances, or if other solutions should be considered. Become their ally and address their concerns—including aesthetics, finances, timeframe, and comfort. Also discuss the reasons your oversight is imperative to a successful outcome throughout treatment. Moving teeth is a medical procedure that is best supervised by an orthodontic specialist. Also educate them on the dangers of using a DIY treatment, so they don’t consider this option.
4. Communicate—This cannot be overemphasized. Open communication throughout treatment is important to assure realistic expectations regarding outcomes. One of the benefits of your expertise is not only to advise the patient about possible risks, but also to adjust methods during treatment to help reach a positive result. Ongoing communication and adequate treatment appointments are critical to an outcome that is acceptable to the patient. Clear aligners may seem like a good choice for patients because they are invisible, more comfortable (no wires or brackets), and easily removed for eating, drinking, brushing, and flossing. However, the very fact they are removable can be a problem since successful treatment largely depends on them being worn a minimum number of hours per day. If patients remove the aligners and don’t wear them properly, the treatment will—at best—be delayed, and—at worse—prevent reaching the desired outcome. Patients must understand their role and the importance of compliance in working with the orthodontist and in maintaining excellent oral hygiene (which is also true of traditional braces). It must be emphasized to the patient that eating and drinking with the aligners in place can severely damage the teeth in a very short time.
5. Document—Of course, stressing this step is always key to avoiding possible litigation. After you have evaluated and explained a patient’s options, it’s important to document what was discussed and get patients (or their guardians) to sign the appropriate documents. This assures you are doing your part and can help avoid litigation that could result from a negative outcome. To make it easier, take advantage of the many resources provided by the American Association of Orthodontists on its website under “Practice Management.”

The primary way to avoid pitfalls is to keep patients from assuming expectations that are unreasonable. There are limitations to the effective and efficient tooth movement with aligners that must be explained clearly and understood. If they are informed of their options, understand their role in successful treatment, and maintain realistic expectations, they are less likely to be unhappy with the results. Of course, when it comes to professional liability, the AAOIC is always here to help. Learn more about the malpractice insurance selected by most orthodontists.

Sources:

“Treatment with Clear Aligners.” American Association of Orthodontists, Web. 7 September 2018.

Kulshrestha, Rohit. “Clear Aligners vs Fixed Orthodontic Treatment – Where Are We Now?” Journal of Dentistry & Oral Disorders. Web. 27 October 2017.

Rinchuse, Donald J, and Dara L Rinchuse. “Risk Management: Supplemental Informed Consent Documents – Legal Matters.” Orthodontic Practice US. Web. 22 June 2018.