Many challenging situations arise when we treat severe rotations with clear aligner therapy. Our focus is on achieving predictable results and developing effective treatment plans using the tools available with this appliance system. When we manage severe rotations, we can implement some key concepts to reach our desired outcomes.
Create space
It is critical to open more than sufficient space for tooth movement to occur. We create the room, implement a proper force system and sustain these forces for the right amount of time. When you design digital treatment plans, adding space and a buffer for any aligner lag are good habits when managing challenging movements, especially rotations. I use the CAD software to create visible areas around the complex rotations and teeth that overlap.
Rotational force feature
When rotations are present and we want to develop a proper force system, make sure your CAD design has a well-staged movement pattern like a hinge motion. The final position should also be over-treated, and an appropriate force system needs to be in place. The force features can be pressure points in the aligner or attachments that coincide with aligner activation for rotations. If we evaluate the attachment hierarchy rules, rotational design should prioritize above all other directions. We ensure to customize the force system to the patient’s malocclusion in the software.
Rotational adjuncts
When we need pure rotational movement, attachments alone can be challenging. Attachments and aligner force features will be more effective in hinge motions and combinations of rotation and buccolingual movements. When a complex rotation is present, consider adjuncts such as buttons and power chains the make the treatment more predictable.
