For information regarding engagers not fitting in the aligner, refer to the following:
When an engager is not lining up with the space created for the engager in the aligner, it can cause discomfort or pain when applying and removing the aligners, and can delay the movements of the affected teeth towards the final result indicated in the treatment setup. Another term used to describe this situation is to say that the engager is "not tracking".
Engagers not fitting in the aligner can be caused by any of the following:
- When a patient is non-compliant
- Tooth movements (rotations, extrusions, intrusions, torquing, tipping, translating) have not occurred due to insufficient pressure or insufficient space
In this situation, you don't want to force the aligner into place over the misaligned engager - this can do more harm than good and move the tooth in unwanted ways.
Instead, try the following:
- Remove the engager that's not fitting in the aligner, and use the previous aligner as a template to place a new engager on that same tooth.
- Check for tight contacts that may be preventing movement and, if you find any, follow instructions given for breaking tight contacts.
- Try backtracking with the previous aligner, the teeth may just need more time to make the needed movement.
- Though the engager will still apply pressure to the tooth and work toward completing that difficult movement, there may be a slight gap in the aligner because that tooth will be moving a little behind schedule. (In the meantime, Chewies may help close those gaps.)
- If the aligner fits everywhere else, remove the engager that isn't fitting into the aligner and continue with treatment. That particular tooth may not move as scheduled on the treatment plan, but the movement can be completed later with a revision (additional charges may apply) at the end of treatment or by using auxiliaries or dimples.
- If all else fails, remove the engagers from all of the teeth, take new upper and lower impressions, and request a case revision (additional charges may apply). This may delay treatment, but it will allow you to adjust the treatment plan for that particular tooth.