Invisalign Quick Start Guide I. All you need to know to start treating Invisalign patients with confidence.

Transcription

1 Invisalign Quick Start Guide I. All you need to know to start treating Invisalign patients with confidence.

2 Index. Index Section : Getting Started Checklist. Section : Invisalign treatment supplies. Section : Clinical preferences. 6 Section : Treatment Evaluation 8 Section : Submission process. 9 Section 6: Patient photographic records. Section 7: Digital impressions - itero Ortho scan. Section 8: PVS impressions one-step modified technique. Section 9: Treatment plans review. Section 0: Tooth movement assessment. 6 Section : Attachments placement. 9 Section : Interproximal reduction (IPR). 0 Section : Treatment monitoring. Section : Treatment monitoring FAQ. Section : The Invisalign support. Images and content are subject to change.

3 Getting started with the Invisalign System - checklist. 0 Step. Step. Step. Log in on the IDS. Download ClinCheck Software. Discover all your online Invisalign educational resources. Step. Go to the WebStore and order submission materials. () Step. Check out the UPS instructions. () Step 6. Sign up for the New Customer Programme discount scheme. Step. Log in on the Invisalign Doctor Site (IDS). Use your username and password to access your Invisalign personal domain (IDS). You will be directed to your landing page. Take some time to visit the different tabs to get an overview of IDS and all the possibilities and resources you can find on it. Step. Download ClinCheck Software. Click on the Support tab on IDS; then go to the Technical Support subtab. Click on Learn more under the Software download section to download and install the software. Step. Discover all your online Invisalign educational resources. Education tab: with more than 80 educational assets (documents, videos, interactive tools) to support you throughout your Invisalign journey from patient selection to retention. E-Connects: online interactive workshops coordinated by an Invisalign Clinical Advisor to share tips and techniques about the Invisalign practice. ()Steps and are not applicable if you use intra-oral scanner instead of PVS impressions to take patient s dental records. Intra-oral scans can be directly sent via IDS. UPS and the UPS brand mark are trademarks that are used with permission by the owner, United Parcel Service of America, Inc. All rights reserved.

4 Getting started with the Invisalign System. 0 Step. Go to the WebStore and order submission materials. () Go to the WebStore and click on Submission Materials, select items and add to cart. Click on check out. Select shipping and billing address, review order details, and click on Place the order (you can print an order confirmation). Step. Check out UPS instructions. () Go to the Support tab; then to the Forms Glossary subtab. Download UPS instructions. Follow the steps in the document for manual or automatic submission to send the dental records of your Invisalign patients. Step 6. Sign up for the New Customer Programme discount scheme Go the Account tab, then click on the Advantage subtab and find out more about your New Customer Programme and relevant discounts. 6 ()Steps and are not applicable if you use intra-oral scanner instead of PVS impressions to take patient s dental records. Intra-oral scans can be directly sent via IDS. UPS and the UPS brand mark are trademarks that are used with permission by the owner, United Parcel Service of America, Inc. All rights reserved.

5 Invisalign treatment supplies. 0 Materials needed for submissions: For online photos: Digital camera ( megapixel with macro-focusing lens recommended). Cheek Retractors. Articulating Paper. Photographic / Palatal Mirrors. Adobe Flash Player 0. For Dental Records:. For PVS impressions: PVS materials for impressions. Vinyl, nitrile or powder free latex gloves. Invisalign impression trays Small, medium, large and x-large trays are available. Procedure Log in to Invisalign Doctor Site. Enter username and password.. For virtual impressions: itero intra-oral scanner. itero Ortho Software. itero Scan Sleeve. Cotton rolls and water for cleaning of lense. Select WebStore tab and browse for supplies. Materials needed for treatment: For attachment placement: Composite material for creating attachments.* Bonding agent such as G-bond. * Composite Dispenser.* Finishing burs to remove any flash. Unwaxed floss to check Interproximal contacts. Select items and add to cart. Dental supplies for Interproximal reduction (IPR): Oscillating diamond coated disk/strip.* High speed bur.* Slow speed diamond disk.* Manual diamond strip.* Polishing strips.* Measuring gauge.* * Please refer to manufacturer s Instructions for use. Select Ship to and Bill to locations, then continue to checkout.

6 Clinical preferences. 0 Clinical preferences are instructions that Providers can specify on the Invisalign Doctor Site (IDS) that provide specific guidelines for creating ClinCheck treatment plans consistently for all their patients. They are automatically integrated in the Provider s ClinCheck plan through the software that creates the set-up, Treat. Therefore we recommend you to fill them in before the first submission. Otherwise, defaults will apply (see next page). Access clinical preferences by clicking on the upper right link. They cover:. Tooth numbering system.. Dual arch treatment.. Passive Aligners.. IPR on first ClinCheck treatment plan.. Delay stage to start IPR, attachments and extractions. 6. Pontics for open spaces. 7. Arch expansion. 8. Expansion per quadrant. 9. Tooth size discrepancy. 0. arch tooth levelling.. Aligner trimming for gingival recession or large undercuts.. For space closure, apply virtual c-chain.. Attachments.. A-P correction resolving conflicts with Precision Cuts and Optimized Attachments.. Stage to start Precision Cuts. They can also be modified for one patient only, when filling in the prescription form of that very patient: current clinical preferences are displayed on the right hand side of the screen so that the provider can choose to modify them for this specific patient. The clinical preferences of a patient are displayed on the prescription form summary, for the Provider to refer to when checking the ClinCheck plan. 6

7 Clinical preferences. 0 If the clinical preferences are not set-up, Align default will apply as follows: Clinical preference. Tooth numbering system. Palmer (UR8 - LR8).. Dual arch treatment. Simultaneous finish. Simultaneous start.. Passive Aligners. Yes. IPR on first ClinCheck treatment plan. Yes. Delay stage to start IPR, attachments and extractions. No delay available. No 6. Pontics for open spaces. Pontics will be placed for anterior and posterior spaces greater than mm. 7. Arch expansion. Not Available. Increasing the width of the canines, premolars, and molars. 8. Expansion per quadrant. 9. Tooth size discrepancy. Not Available. Less than or equal to mm per quadrant. Leave space distal to the (upper) laterals. 0. arch tooth levelling.. Aligner trimming.. For space closure treatment, apply virtual c-chain. Levelling the incisal edges, with the lateral incisors being positioned 0.mm more gingival than centrals. Trim aligners to / way between gingival margin and CEJ (cement to enamel junction) line. None. Attachments. Please refer to the attachments protocols in the document about SmartForce features. Precision Cuts by default:.a-p correction resolving conflicts with Precision Cuts and Optimized Attachments. Not Available. Class II (Hooks on upper canines and Button Cutouts on lower first molars). Class III (Button Cutouts on upper first molars and Hooks on lower canines). By default, in case of incompatibility, Optimized Attachments will be prioritised.. Stage to start Precision Cuts. Not Available. Stage. 7

8 Treatment Evaluation 0 Key Factors Three critical elements for treatment evaluation:. Patient motivation Highly motivated patients are more likely to be compliant. Patient compliance is essential to get the best clinical results, even for simple treatments.. Treatment goals and strategies Some movements are more predictable with the Invisalign System, whilst other require closer monitoring and expertise.. Experience As for any other orthodontic technique, there is a learning curve with the Invisalign System. What can be achieved, is based on experience and confidence. Treatment Evaluation Tool We have developed guidelines to help you assess the simplicity or complexity of treating a specific patient with the Invisalign System, based on the patient s clinical condition and your treatment plan by classifying treatments as green, blue or black as shown below. () Green Blue Black Surgery No No Yes Extraction No Incisor extraction Premolar extraction Distalization <mm -mm >mm Mesialization No <mm >mm Crowding <6mm 6-8mm >8mm Spacing <mm -8mm >8mm Expansion per quadrant Anterior crossbite <mm -mm >mm Involving tooth Involving bilateral teeth Involving multiple teeth Anterior intrusion <.mm.-mm >mm Posterior intrusion No <mm >mm Anterior extrusion <.mm.-mm >mm Posterior extrusion No <mm >mm If all items are in the Green column > Green treatment: Simple treatments and/or more predictable treatment approaches. If at least one item is on the Blue column and none in the Black column > Blue treatment: Moderate treatments and/ or variably predictable treatments approaches. If at least one item is on the Black column > Black treatment: More complex treatments and/or less predictable treatment approaches. To help you assess the degree of complexity of treating a specific patient with the Invisalign System, you can use the table above or the Treatment Evaluation Tool on IDS. You can also check the International Invisalign Gallery, with more than 0 Invisalign treatments. () Note that there is no connection between the green/blue/black categories and the different Invisalign Treatment Options i7/lite/full/teen 8

9 Submission process. 0 Tips tricks. Retain an original copy of all records, submitted records will not be returned. For your own records take alginate impressions to create study models, or take intra-oral scan if desired. Invisalign submission box checklist. The following records are required for Invisalign treatment submission: and lower PVS impressions or intra-oral scan. Online prescription form. Online photos (extra-oral are optional). Procedure STEP : Add a New patient. Select add a New patient. Enter patient Data. Choose patient specific Clinical Conditions (optional step). 6 Upload patient Portrait and Photographs. Upload patient Radiographs if desired (optional step). New Patient File will now appear under patients list. 9

10 Submission process. 0 Procedure STEP : Start a Prescription. Select Start Prescription.. Choose Invisalign treatment option. Fill out questions with specific patient treatment plan. 6 Upload patient Photos (intra-oral required, extra-oral optional). Upload Radiographs (optional step). Check summary of the prescription form before submitting it Print out print shipping page with barcode and include it in the Invisalign submission box. Optional: Print out the prescription form summary with barcode and include it in the Invisalign submission box. Final submitted prescription form available at Patient File Page for reference. 0

11 Submission process. 0 Procedure STEP : Prepare Box for Shipment. Use Invisalign submission box. Insert records into submission box with print shipping page (printed prescription form is optional to include). CHECKLIST FOR REQUIRED PATIENT RECORDS Provider (Print Name) Patient (Print Name) Patient ID # PLEASE FILL OUT THIS CHECKLIST AFTER FILLING OUT THE ONLINE PRESCRIPTION FORM AND INCLUDE THEM IN THE SUBMISSION BOX. Please let us know if the required patient records are enclosed in the box or were submitted online by checking ( ) the appropriate box. Failure to provide all the required records will result in processing delays of this case. If one or more items are missing, the case will not be processed until all records are received. PATIENT RECORD INCLUDED IN BOX SUBMITTED ONLINE. impression or intra-oral scan. impression or intra-oral scan. Photos. Completed prescription form. Print Shipping Page Important: Impressions must be properly disinfected. Important: Impressions must be properly disinfected. Printed shipping page with barcode must be included in the submission box. Online prescription form needs to be submitted prior to the box shipment and a copy must be included in the box. Online prescription form needs to be submitted prior to the box shipment, and a copy is optional to be included in the box. CHECK-LIST POUR LES DOCUMENTS REQUIS POUR LE PATIENT Records necessary for submission of an Invisalign order may not be adequate for complete orthodontic diagnostic purposes.

12 Patient photographic records. 06 Tips tricks Extra-oral photographs. Patient should stand against a white or lightly coloured non-distracting background. Keep patient slightly away from the background to reduce shadows. Have patient close in maximum intercuspation. Materials needed. Digital camera. Procedure. Right Profile. Frontal Repose. Frontal Smiling. Tips tricks Intra-oral photographs. Eliminate all distractions in the field of view: saliva, lipstick, blood, etc. Include only teeth and surrounding gingival margins in photo (position camera, zoom). Using retractors, pull lip out of intra-oral photo view. Mirrors can be placed in warm water to prevent fogging during use. Materials needed. Digital camera. Cheek Retractors. Photographic / Palatal Mirrors. Articulating Paper. Procedure. Anterior, Frontal. Maximise cheek retraction as patient bites down completely. Centre midline; buccal surfaces of molars should be showing. Buccal, Right and Left. Maximise exposure of the molar region by pulling retractor towards the ear. Capture molar/canine relationship; position camera perpendicular to buccal segment. Occlusal, and. Recline chair and patient s head as far as possible; tilt patient s chin up (with mouth open). Mark occlusal contacts with articulating paper. Position occlusal mirrors at rear of terminal molar and opposite arch incisors. Centre midline; take photo of image in mirror at 6 angle to mirror surface.

13 Digital impressions - itero Ortho scan. 07 Tips tricks. Use special Invisalign Scanning Technique (as seen in training. Can be checked again on the Education tab on IDS). Run Invisalign Outcome Simulator (IOSim) for improved patient/provider communication. Materials needed. itero intra-oral scanner. itero Ortho Software. itero Scan Sleeve. Cotton rolls and water for cleaning of lens. Procedure. Scan patient and register bite. Process model in viewing mode, fill holes if needed. Send Invisalign scan. Connect to IDS and add Invisalign scan for patient submission. The IOSim helps gain patient acceptance by making it easier to show what their Invisalign treatment outcome might look like.

14 PVS impressions one-step modified technique. 08 Tips tricks. Wear vinyl, nitrile, or powder free latex gloves. Use Invisalign impression trays only. Use PVS for impressions, not other materials. Use a timer to monitor setting time. Procedure. Materials needed. Putty.* Light or medium-body wash PVS. Invisalign impression trays. Technique Note: To get the best results, Providers should use the impression technique with which they are most comfortable. Mix putty. Mix putty evenly for 0 seconds with fingers. Ensure you have no streaks and colour is even. Latex powder can interfere with proper setting. Place putty bites in posterior of tray. Adapt putty to tray walls. 6 Insert tray. Press fully to seat where the molars are impressing in the putty and gently wiggle. Pull the upper lip over the tray. Immediately pull the tray out. Push out all the details in the putty. Create a distal ledge. Dam to prevent flow of material. Ensure capture of distal of nd molar. Remember to work quickly, you want the putty to stay soft Remember to bleed your cartridge first to assure material is properly mixed. Keep tip submerged in material to avoid air bubbles. For an upper impression, you do not need to cover the palate. Overflow both ends of the tray to capture distal of nd molars. Immediately seat impression in patient s mouth fully without incisal edges hitting the tray. can go into the putty. Pull lips over tray. Key is to vertically seat the impression evenly, without tilting. Seat slowly to allow air to escape. Hold steady for minutes or the setting time indicated by the manufacturer Instructions. All teeth captured in the impression. Approximately -mm of gingiva captured in the impression. Detail in palate is not necessary. * Please refer to manufacturer s Instructions for use.

15 Treatment plans review. 09 Tips tricks. ClinCheck software is required to review all treatments. Install ClinCheck software from the IDS. ClinCheck software should be installed on all computers you plan to use/access for patient records, treatment planning and patient consultation purposes. Download the latest version of ClinCheck Software. Go to vip.invisalign.com Go to Support tab, and then to the Technical Support subtab. Download the latest version of the ClinCheck software. Procedure. Check the initial bite. Check the animation and the Staging tab. Check the Comments tab. Check the final position. Check the Treatment tab ( especially the tooth movement assessment - see section 8).

16 Tooth movement assessment. 0 Purpose. The Invisalign tooth movement assessment provides guidance in identifying more significant movements present in the ClinCheck treatment plan, and skills that may be needed for the treatment. Summary view. Highlights teeth with movement above a set threshold. Tooth movement colour. Details view. Details of the teeth highlighted and coloured above. A O T H MO V E ME N T A S S E S S ME N T B C D E F Tooth Assessment Movement Align Technology, Inc. 60 Orchard Value Pkwy, San Jose, CA 9 Range Tooth A ssessment Movement V alue R ange. (UR) Blue Blue Extrusion Extrusion 0.9 mm 0.9 mm 0. mm -.0 mm 0. mm-.0 mm. (UR) Black Black I Extrusion. mm. mm >.0 mm >.0 mm 7. (UR) l Blue Rotation Rotation - 7. (UR) Blue Blue Extrusion Extrusion..7 mm. -. mm G Right Quadrant Blu Blue e A-P Correction.. mm mm.0 mm -.0 mm A B C D E F G Column identifies teeth highlighted in the summary view. Column identifies the colour for each tooth. Column identifies five types of movements that are above a set threshold (rotation, extrusion, intrusion, root movement or A-P correction). Column identifies the amount of movement programmed in the ClinCheck treatment plan. Column identifies the range that informs the colour category. Row shows example of tooth with compound movements. Row shows example of an assessment with A-P correction. 6

17 Tooth movement assessment. 0 Tooth movement colour. Blue Moderate movements. Skills/techniques that may be required. The movements programmed have shown good results with the use of aligners and at times, benefit from additional techniques like the ones noted to the right; closer monitoring is recommended. Treatment management. Additional Aligners/refinement may be needed. Black Advanced movements. The movements programmed have shown good results with the use of aligners, but often require additional orthodontic techniques as they are more challenging to achieve with the use of aligners alone; very close monitoring is recommended. Treatment management. Additional Aligners/refinement may be needed. Blue and Black Additional options. Change ClinCheck treatment plan to remove the specific movements and/or change treatment goal. May result in a compromised ClinCheck treatment plan. Post-Invisalign restorative solutions may be considered as part of the treatment plan. Notes: If a Provider requests to remove or change a default attachment that has been automatically placed according to the Invisalign Clinical Protocols, the tooth/teeth will be identified as blue or black and may require additional clinical skills and close monitoring. Anterior IPR Posterior IPR Attachments Monitoring interproximal contacts Detail pliers Pontics Button Elastics for Extrusion Buttons Elastics for Rotation Inter-arch Class II/III elastics w/ Precision Cuts Sectional Fixed Braces Full Fixed Braces Pre-PVS treatment (expansion, A-P correction) Orthognathic Surgery The colour categories for assessing the difficulty of a treatment are provided for the Provider s reference only, based on the ClinCheck treatment plan. Each patient s situation is different. Provider is solely responsible for evaluating whether Invisalign treatment options and/or products are appropriate for use with each patient and waives any claims against Align relating to the treatment or outcome of treatment. The tooth movement assessment displays movements of extrusion, intrusion, rotation, root movement and A-P correction, which are programmed in the ClinCheck treatment plan. 7

18 0 Tooth movement assessment. * RANGES RANGES APPLIED APPLIED TO TO TOOTH TOOTH MOVEMENT MOVEMENT CATEGORIES CATEGORIES** Ranges applied to tooth movement categories.* RANGES APPLIED TO TOOTH MOVEMENT CATEGORIES* Extrusion Extrusion Extrusion Extrusion. Intrusion Intrusion Intrusion Quadrant Quadrant Quadrant Quadrant Intrusion. 0mm 0mm mm 0mm mm 0mm mm 0mm mm 0mm mm 0mm of root apex Root Movement Measured by displacement of root apex Root Movement Measured by displacement 0mm of root apex Root Movement Measured by displacement 0mm mm Root movement. Measured by displacement of root apex. A-P Correction Per quadrant A-P Correction Per quadrant A-P correction. A-P Correction Per quadrant Per quadrant. Quadrant Quadrant Quadrant Quadrant Quadrant Quadrant 0 mm Quadrant Quadrant 0mm mm 0 mm Rotation Rotation. Rotation Rotation mm 0mm 06 mm 6 mm 06 mm mm mm 00mm 6 6 0mm * These ranges are applied as a guideline to assess the extent of movement present in the ClinCheck treatment plan * These ranges of movement the ClinCheck treatment plan. are applied as a guideline to assess the extent present in ** These are applied of present as These ranges ranges are applied as a a guideline guideline to to assess assess the the extent extent of movement movement present in in the the ClinCheck ClinCheck treatment treatment plan. plan. 8

19 Attachments placement. Tips tricks. Bonding to porcelain can be difficult and technique sensitive. If you need to bond an attachment to porcelain, use dental products designed to help condition porcelain so that attachment material may adhere to them. To prevent attachments from losing their shape or de-bonding, Align recommends the following dental composite materials: Ivoclar Tetric EvoCeram (with GC G-Bond bonding agent). M Filtek Supreme Plus (with M Adper Prompt L-Pop bonding agent). M Filtek Z0 (with M Adper Prompt L-Pop bonding agent). Materials needed. Attachment template. Attachment materials or similar dental supplies, including: Composite material for creating attachments.* Bonding agent.* Finishing burs to remove any flash. Composite dispenser. *Please refer to the ancillary products manufacturer s list accessible via the Education tab on IDS. Procedure. Test fit. Rinse the attachment template in cold water and test fit in the mouth. Isolate teeth for bonding. Isolate the teeth and prepare each tooth that will receive an attachment according to the material instructions. Match tooth shade. Thoroughly dry template and load a small amount of attachment composite into each attachment well of the template until it is slightly overfilled. 6 Conform to teeth. Fully seat the loaded template onto the teeth and apply gentle pressure around each attachment to ensure full adaptation. Cure attachment. Cure each attachment according to composite manufacturer s instructions. Remove template and flash. Remove the template and any flash from the teeth using a carbide finishing bur. Repeat process for opposite arch. Note for Root Control Attachments: Optimized Root Control Attachments are smaller than other attachments, additional care and consideration should be taken when bonding to your patient s teeth. In order to minimise flash between the attachments do not attempt to deposit the composite directly from the unidose capsule into the template. This method does not dispense small amounts well. For better results, try dispensing the composite onto a dental composite spatula instrument, then transfer the composite into the attachment well of the template and remove excess. 9

20 Interproximal reduction (IPR). IPR techniques. Manual diamond strips: Technique particularly effective for smaller amounts of IPR (0.mm or less) and anterior teeth. Start with the finest strip and work up to the most coarse; increases accuracy and minimises compression of the periodontal ligament. Protect patient soft tissue with retractors or cotton gauze. Open interproximal contact with the thinnest diamond strip. Use a gentle back and forth motion until the strip is passive. Step to a thicker strip to widen the contact. Work to the thickest strip needed. High speed bur: The smallest IPR increment that can be performed with the bur is 0. 0.mm. To improve access to the contact area, interproximal wedges can be temporarily placed. Take care near the cervical regions of contact to avoid creating ledges. Break interproximal contact with light, even, brush-like movements. Use water spray to help reduce clogging and overheating of bur. Slow speed diamond disk: Break any tight contacts with a diamond strip before using the diamond disk. To improve access to the contact area, interproximal wedges can be temporarily placed. Use a disk guard, dental mirror, or tongue depressor to protect patient s soft tissue. Spin disk lingually using slow RPM s. Engage the disk against the tooth surface. Oscillating technique: Single or double-sided disks or strips are used in conjunction with an oscillating electric hand piece for enamel reduction (0.-0.mm) with reduced risk of damaging soft tissue. Insert the disk/strip into the interdental space from occlusal with a gentle continuous movement. Apply light continuous movement (up-down or back-forth) following the contour of the tooth. Sequentially use from the thinnest to the thickest disk/strip until the target amount of enamel is reached. Start the oscillating disk before it is applied to the tooth. Do not allow the disk/strip to remain in one place and use generous waterspray coolant at all time. Procedure. Review/perform IPR. Review the IPR amounts on the form included in the aligner box. Determine appropriate IPR method. Confirm removal. Confirm the amount of interproximal enamel removed with thickness gauges. Feel for slight tactile resistance when the correct amount has been removed. Polish/verify. Polish interproximal surface with polishing strips, until adjacent surface is rounded and smooth. Verify the final gap dimension with thickness gauges. Record date and amount of IPR in patient record. Each Provider takes full responsibility and is solely liable for the techniques and methodologies used in treatment. Providers are encouraged to utilise the techniques and materials that are best suited for each patient. Please refer to manufacturer s Instructions for use. 0

21 Treatment monitoring. Tips tricks. Check the ClinCheck treatment plan before the patient is in the chair. Have a computer with the ClinCheck file open next to the chair. Material needed. Dental floss. Polishing strip. Procedure. Check attachments. Are they present? Are they sheared or worn? Good fit. Check the last aligner fit. Poor fit. Check contact points with dental floss and release with polishing strip if binding. Check against ClinCheck file to validate progress. Place attachments and proceed with IPR, if applicable. Optimized Attachments have a different shape to the recess in the aligner, and they can have Activation, meaning that they are positioned by the template on the tooth with an offset relative to the position of the attachment recess in the aligner. The software determines the shape of the aligner with two considerations:. The Active Surface of the aligner engages the Active Surface of the Optimized Attachment and produces the force required for tooth movement - there is no gap at the Active Surface.. Non-Active Surfaces have intentional gaps for clearance. No unwanted forces are produced.

22 Treatment monitoring FAQ. Question: Why is the shape of the Optimized Attachment different from the shape of the attachment recess in the aligner? Why do I see a gap between the attachment and the aligner? Answer: The aligner shape in the area of the Optimized Attachment is NOT the same as the attachment. The software determines the shape of the aligner with two considerations:. The Active Surface of the aligner engages the Active Surface of the Optimized Attachment and produces the force required for tooth movement - there is no gap at the Active Surface.. Non-Active Surfaces have intentional gaps for clearance. No unwanted forces are produced. Non-Active Surface (Gap) Active surfaces (no gap) Fig. Active Surface of Optimized Attachment. Question: Can I use a patient s aligner to re-bond an attachment that has fallen off? Answer: This depends on the kind of attachment:. Conventional attachments: It is fine to use the aligner to produce these conventional attachments.. Optimized attachments: It is not recommended to use the aligner to produce Optimized Attachments. This is because Optimized Attachments have a different shape than the recess in the aligner (see fig. ), and they have Activation (see fig. ), meaning that they are positioned by the template on the tooth with an offset relative to the position of the attachment recess in the aligner. If an Optimized Attachment falls off or is broken during treatment, an additional attachment template may be ordered via IDS on the patient s file. If the situation requires a more immediate solution you may use the original attachment template and cut out the specific tooth to re-bond an Optimized Attachment. An additional attachment template can be ordered for any existing aligner stage. Activation Fig. Activation of Optimized Attachment. Click to order attachment template IDS Patient File showing how to order attachment template.

23 Treatment monitoring FAQ. Question: When taking a new impression or intra-oral scan for Additional Aligners or refinement, do I need to remove the attachments? Answer: Yes. All attachments should be removed before taking a new impression or intra-oral scan. Optimized Attachments must be removed in order to allow the activation to be built back in with the additional aligners. The software will place the Optimized Attachments according to the shape and current position of the tooth, which will change the active surface location. Therefore old Optimized Attachments must be removed before taking a new impression or intra-oral scan. It is recommended to also remove conventional attachments. Question: With premolars, why on some treatments do I see two buccal Optimized Root Control Attachments and on some I see just one? Answer: When there is sufficient tooth surface two Optimized Root Control Attachments are placed on the buccal surface of the tooth. When there is insufficient tooth surface or interferences predicted throughout treatment, one Optimized Root Control Attachment will be placed on the buccal surface and a Pressure Point will be placed on the buccal aspect of the aligner. Question: On an upper lateral with the Optimized Root Control feature, it appears the aligner is not seated on a portion of the tooth near the incisal edge. Is this normal? Answer: In order to produce the desired force system, an aligner space is created between the tooth and the aligner along the incisal mesial or incisal distal aspect of the tooth. The aligner space is positioned on the aspect of the tooth opposite the attachment. The aligner space removes unwanted contacts that would produce unwanted forces. The aligner space appears only on the upper lateral with the Optimized Root Control Attachment. Question: If the Pressure Point and aligner space help the root movement for the lateral incisor, why are they not present on the central incisors? Answer: The central incisors are larger teeth and generally have sufficient tooth surface to place two Root Control Attachments, so the Pressure Point and aligner space are not needed. Pressure Point Pressure Point Aligner space Aligner space Fig. Aligner space on aligner at upper lateral incisor, combined with Optimized Root Control Attachment and Pressure Point. Fig. Aligner with Optimized Root Control Attachments on the central and lateral incisors, with Pressure Point and aligner space on lateral. For more information on using attachments for Invisalign Treatments visit the Education tab in your Invisalign Doctor Site (IDS)and go to the Attachments section.

24 The Invisalign support. Services helping you optimise your Invisalign treatments.. Practice support. The Invisalign Doctor Site (IDS). Your personal Invisalign website provides you with everything you need to ensure your practice runs smoothly. You can: Access real-time treatment status information. View, modify and approve your ClinCheck files. Order marketing materials and print advertising through the WebStore. Keep up to date with Invisalign news and updates.. Invisalign support. Customer Care. Call your Invisalign Customer Care representative for support with general enquiries, or help redirecting your call to the appropriate team. Available: Monday to Thursday 09:00 8:00 (GMT). Friday 09:00 6:00 (GMT). Clinical support. Our experienced Clinical Advisors are on hand to answer any clinical enquiries including ClinCheck treatment plan reviews, treatment troubleshooting and tips and techniques. Territory Manager. Your local Territory Manager, together with our technical support team are available to help with any clinical questions, team starts, staff training and practice development. They can also provide more details on marketing Invisalign in your practice. Invisalign Contact Information. Your IDS Info: (please keep confidential) User Name: Password: IDS : Customer Care: Name: Tel: Fax: Territory Manager: Name: Tel: vip.invisalign.com For the current overview of seminars or to register online, please go to: aligneu.com. Educational support. The Invisalign Education pathway provides you and your staff with the Invisalign fundamentals to help you confidently treat patients with Invisalign. For local UPS information, please see the UPS Instructions document located under the Support tab on your IDS, under section Forms Glossary. UPS and the UPS brand mark are trademarks that are used with permission by the owner, United Parcel Service of America, Inc. All rights reserved.

25 0 Align Technology (BV). All Rights Reserved. Invisalign, ClinCheck and SmartTrack, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. B Rev C