For information regarding dimples and where to place them, refer to the following:

• Definition, Use, and Information
• Placing dimples for adding tension
• Placing dimples for rotations
• Placing dimples for tipping
• Placing dimples for torquing
• Placing dimples for translation

Definition, Use, and Information

Definition: A dimple is a small depression made in the plastic of the clear aligner. The dimple increases pressure on a tooth to help make desired tooth movements or to increase retention of the aligner.

Uses: Dimples can be used for:  

• Rotations
• Minor tipping movements
• Buccal/lingual movements
• For adding retention to the aligners (Note: The need for this is often caused by a lack of adequate retention points. Aligners work best with bulbous teeth. Teeth with short clinical crowns or flat buccal and lingual surfaces are problematic. Engagers may be used to provide aligner retention.)

The force made by dimples will only be as strong as the aligner's strength, so it's best to place dimples in a fresh aligner that has not been worn yet or request a replacement aligner if retention is inadequate.

Overcorrection & Dimpling:

If overcorrection is requested in the treatment setup, it reduces and often negates the need for dimpling. Whenever possible, planned overcorrection in the treatment setup is more advantageous than making dimples (since dimples need to be made for each aligner and are generally limited to one or two teeth).

Dimpling is used as a chairside measure to increase pressure on the tooth for difficult movements. However, the amount of tooth movement is limited as there must be adequate space on the opposing side of the dimple within the aligner to allow the tooth to move. Often this is limited to the size of the air gap between the aligner and the tooth. 

There are different approaches to overcorrection and dimpling. Some clinicians prefer to utilize overcorrection as much as possible and dimple only for difficult movements. Others do not plan overcorrection and dimple the aligners as needed, however as described above, dimpling only works for select movements.

How to... 

Dimples are made using a dimpling plier. Be aware that different manufacturers make dimpling pliers that produce slightly different sized dimples and some pliers require heating while others do not. Refer to the plier manufacturer for specific instructions.

Placing dimples for adding tension

 To add additional retention to aligners - place a dimple between two teeth on the lingual and facial sides of the aligner.

Placing dimples for rotations

For distal rotations - place dimples on the lingual mesial and facial distal side of the tooth.

For mesial rotations - place dimples on the lingual distal and facial mesial side of the tooth

Placing dimples for tipping

For facial tipping, place dimples on the lingual mesial and distal sides of the tooth.

For lingual tipping, place dimples on the facial mesial and distal sides of the tooth.

For mesial tipping, place dimples on the lingual and facial of the distal surface of the tooth on the occlusal 1/3.

For distal tipping, place dimples on the lingual and facial of the mesial surface of the tooth on the occlusal 1/3.

Placing dimples for torquing

NOTE: (Engagers are recommended for torquing but not for small movements. Fresh aligners are the best option to get a tooth to torque. You may end up needing more than one replacement for stubborn teeth.)

To torque lingually, place one dimple on the facial gingival. 

To torque facially, place one dimple on the lingual gingival.

To torque mesially, place dimples on the facial and lingual of the distal surface of the tooth on the gingival.

To torque distally, place dimples on the facial and lingual of the mesial surface of the tooth on the gingival.

Placing dimples for translation

NOTE: Engagers are necessary for large mesial and distal movements. IPR may be needed if there is contact preventing movement.)

To translate lingually, place dimples on the facial occlusal 1/3 at the center and on the facial gingival.

To translate facially, place dimples on the lingual occlusal 1/3 at the center and on the lingual gingival.

To translate mesially, place dimples on the lingual distal surface of the tooth on the occlusal 1/3 and gingival. And place dimples on the facial distal surface of the tooth on the occlusal 1/3 and gingival.

To translate distally, place dimples on the lingual mesial surface of the tooth on the occlusal 1/3 and gingival. And place dimples on the facial mesial surface of the tooth on the occlusal 1/3 and gingival.

NOTE: Zendura also offers some nice instructions on using pliers with clear aligners:

• • http://www.zenduradental.com/pages/fabrication-minor-tooth-move