Tracking Issues

For information regarding tracking issues, refer to the following:

Definition

When teeth are moving on schedule, as planned in the treatment setup, we say that treatment is "tracking".

However, even if aligners appear to fit properly and comfortably, that doesn't guarantee that the teeth are actually moving as intended.

Some common causes for tracking issues are:

Here are some tips for identifying unseen tracking issues before the treatment goes too far off the rails:

For non-compliant patients, be sure to educate your patient on the importance of wearing their aligners at least 22 hours per day. Signs of non-compliance include missed appointments, unusually clean aligners, and a persistent tight fit after weeks of wear. Make sure your patients know they should contact you immediately if their aligners no longer fit.
Saliva buildup or saliva bubbles inside the aligner often indicates that there is a significant gap between the aligner and the teeth. This will most likely be seen at the incisal edge.
Blanching of tissues indicates soft tissue impingement. This could be the result of inaccurate capture of these areas in the impression or the result of a frenum that extends towards the gingival margins.
If the aligners are slightly ill-fitting when you give them to your patient, but the patient calls back a few days later saying that they now fit, don't rely on that self-assessment. Do a follow-up visit to confirm the quality of the fit before advancing to the next step.
Even if the aligners are fitting during check-up appointments, you should check the treatment setup and paperwork to see which teeth are moving and if those teeth appear to be on course. If you see that a tooth is not moving as planned, don't wait, take immediate action. If you continue with treatment in hopes that it will correct itself later on, it may get worse.