Insufficient Pressure

For information regarding insufficient pressure, refer to the following:

• Definition
• Causes
• Solutions
• Consequences

Definition

When there is not enough pressure on the teeth or tooth to get the desired movement needed in effort to align it's position. See also insufficient space.

Causes

Most teeth will move with a little bit of consistent pressure on them. However, some types of teeth, some movement, and some other factors are more prone to issues than others. These include:

• Maxillary laterals
• Premolars
• Short clinical crowns
• Molars
• Age and health of teeth
• Intrusions
• Extrusions
• Rotations

Solutions

• Engagers
• Dimples
• Overcorrection
• Digital power chains
• Extruding with auxiliaries
• Rotating with auxiliaries

Each of these solutions can increase pressure. The key is knowing when to apply each one.

Engagers may be included in the treatment plan based on your prescription and/or the technician’s recommendation. Engager preferences and timing can be adjusted according to the needs of the patient—just let us know when submitting the case or in a revision.

Dimples can be created in office with dimple pliers. These are used to increase pressure to assist with difficult movements. They can also be used to increase the retention of an aligner when needed, such as with short clinical crowns.

Buttons and elastics can be used to help with extrusions. See our technique for extruding with auxiliaries.

Buttons and elastics can also be used to help with rotations. See our technique for rotating with auxiliaries.

Overcorrection is when the technician stages the last few aligners with a little more pressure in the desired direction to ensure the teeth move into their final position. Overcorrection can be requested in your case submission form at the start of treatment, or in a revision.

Digital power chains can be used to close residual spacing, which can occur if too much IPR was done. Or some cases start with spacing, and you just want to ensure all spaces have closed.

General solutions

Here are some techniques that can assist with both insufficient space and insufficient pressure:

Backtracking is used to get the teeth back on track by having the patient wear an earlier aligner longer before advancing to the next step. You can get best results by requesting a fresh replacement. You can combine this with other solutions, like adding dimples, extruding with auxiliaries, IPR or hand stripping, all designed to get the teeth back on track without requiring a revision.

Longer wear schedules may help with patients that you suspect are non-compliant or need more time to achieve planned tooth movements.

Increasing patient compliance can be achieved with incentives according to what you want to offer. Here are some incentives used by doctors:

• Educating the patient that by wearing their aligners 22 hours a day, they can avoid delays and added costs, and will be more likely to complete treatment within the expected time frame.
• Explaining the alternative (traditional braces) if aligners are not worn 22 hours a day.
• Using the treatment setup as an incentive to be compliant – reminding them of what their teeth could look like if they keep to their wear schedule.

Consequences

The consequences for not monitoring or addressing insufficient space and/or insufficient pressure can include:

• Tracking issues
• Aligners that don’t fit
• Case revisions that prolong treatment time
• Expected results not attained
• Unhappy patients
• Refund requests
• Frustration and stress (for you and your patient)

We hope this article helps you to understand how treatment can go off track, how you can prevent this and how to achieve your desired treatment outcomes.