For FAQs about Auxiliaries, refer to the following:

• General FAQs about Auxiliaries
• FAQs about Cutouts

General FAQs about Auxiliaries:

• What are the main indications for auxiliaries, what are the limitations and side effects?
• How can I predict when I may need to use auxiliaries? I would like to be able to tell a patient that these items may be used in their treatment.
• How do you best use pliers in a situation where a tooth is not moving as predicted?
• Are elastics used when the clear aligner fails to move the tooth or is it sometimes incorporated into the original treatment setup?
• How often should elastics be changed?
• I have difficulty adhering buttons to crowns and to the aligner as well, any suggestions?

What are the main indications for auxiliaries, what are the limitations and side effects?

Auxiliaries enhance the force applied by aligners. When a tooth is not tracking with the aligner, the auxiliaries can direct pressure in the desired direction. Limitations and side effects will vary depending on the type of auxiliary used and how it is applied.

How can I predict when I may need to use auxiliaries? I would like to be able to tell a patient that these items may be used in their treatment.

Predicting the need for auxiliaries gets easier with experience. You can tell your patient that auxiliaries may be necessary when you see difficult movements such as extreme rotations, extrusions, and inter-arch corrections.

How do you best use pliers in a situation where a tooth is not moving as predicted?

Pliers can be used to make "dimples" in the aligner which can help increase pressure on a tooth to help make the desired tooth movement(s) or to increase the retention of the aligner. For more information on the use of dimples, please refer to this article.

Are elastics used when the clear aligner fails to move the tooth or is it sometimes incorporated into the original treatment setup?

It's important to remember one of the basic tenets of clear aligner treatment: when a tooth is properly/fully encased in the aligner material, it cannot be moved except by the forces built into the aligner. Cutouts for elastics can be requested in "Additional instructions" when submitting a case in the Doctor Portal or in the Comments Panel of ClearPilot™. 

Elastics are effectively used in conjunction with aligners in a few scenarios:

1. Class II elastics, Class III elastics, and vertical elastics can be used with aligners to effect dental arch (skeletal) movement. This type of elastic application should be incorporated into the initial treatment plan created by the clinician.
2. Elastics can be used to extrude individual teeth into occlusal gaps in the aligner caused by the teeth not moving as expected. 
3. Elastics can be used to help rotate individual teeth into the desired position if/when the rotation is not occurring with the aligners alone.

If you choose to use elastics to treat Class II or Class III bite relationships, you can request to have slits made in the aligners, cutouts in the aligners where buttons are bonded to the teeth, or a combination of both button and slit cutouts. The preference is up to the treating clinician.

You can find more information about the use of elastics with clear aligners in this article.

How often should elastics be changed?

A general rule of thumb is to change them every time the patient removes them to eat or drink.

I have difficulty adhering buttons to crowns and to the aligner as well, any suggestions?

Due to the flexibility of the aligner material, it can be difficult to keep buttons bonded to the aligner material. However most bonding resins in the market will work well. You may want to consider using the slit cutouts option as an alternative.