Disclaimer: Please note that not all features are available in all markets. Contact your local Straumann or ClearCorrect representative to find out what is available in your area.

Elastics used with cutouts in clear aligners is an effective technique used to correct different types of malocclusion during clear aligner treatment. Class II and Class III malocclusion, open bites and crossbites can all be effectively treated with the use of elastics and cutouts, providing the patient is fully compliant in wearing the elastics as directed by the treating clinician. 

Let's look at some of the ways cutouts and elastics can be used with clear aligners.

For information regarding aligner cutouts, refer to the following:

• Aligner Cutouts for Bonded Buttons
• Aligner Cutouts with Slits in the Aligners
• ClearCorrect Aligners and Cutouts
• Tips for Aligner Cutouts
• Protocols and Requesting Cutouts When Submitting a Case

Aligner Cutouts for Bonded Buttons

This technique involves making semi-circular cutouts in the aligners so buttons or other similar auxiliaries can be bonded to the teeth.  The buttons work as anchorage for an elastic that is attached to the buttons, (for example, one placed on a tooth in the maxillary arch and another on a tooth in the mandibular arch). The elastics pull the teeth in a certain direction (depending on where the buttons are placed) and is most commonly used to correct Class II and Class III malocclusions.

The elastic force applied to the teeth (or alveolar bone if using TADs) can be more effective than pulling on the aligners (as in the technique with elastics and slit cutouts in the aligners), which may cause the aligner to unseat or distort.

The aligners can be modified in-house or by the aligner manufacturer for elastic wear. Usually these are requested during the submission process for the clear aligner case.

The buttons normally remain on the teeth until the correction of the malocclusion is completed.

Example of Buttons & Elastics for Class II Correction

Example Button Cutout for Class III Correction

Examples of Button Cutout for Aligner

Aligner Cutouts with Slits in the Aligners

This technique works similar to the button technique. The difference is that the elastic is worn using slits cutout in the aligner instead of buttons attached to the teeth. 

This is often considered a more convenient technique for the doctor and the staff because it does not  involve any additional steps (i.e., bonding buttons), thus saving time.

It's also a more aesthetic option for the patient, because there are no visible buttons attached to the teeth.

When wearing elastics through slits in the aligners, in some cases, the elastic may distort the aligner away from the teeth. It may also dislodge the aligner off the teeth when they don't fit tightly to the tooth, reducing tooth movement effectiveness. The use of elastics placed on slits may cause tissue irritation.

Example of Slit Cutouts in the Aligners for Class II Correction

Example of Slit Cutouts in the Aligners for Class III Correction

Slit Cutouts in the Aligner

ClearCorrect Aligners and Cutouts

ClearCorrect supports the treatment of Class II and Class III correction through the use of button and slit cutouts in the aligners. There are two ways you can get cutouts made in your ClearCorrect aligners:

1. Pre-made: You can request pre-made cutouts in your aligners during case submission, by indicating in the prescription form on Step 3 when selecting the Bite Classification or the Dental Conditions, or by asking for custom cutout placement in the "Additional Information" section of the prescription form in the ClearCorrect Doctor Portal.
2. In-house: If you own your own button and slit pliers, and you and your staff are properly trained and feel confident in placing the cutouts yourself, you can make the cutouts directly to your ClearCorrect aligners.

Please note that pre-made cutouts may not be available in all markets. Please contact your local Straumann or ClearCorrect representative to find out what is available in your area.

Tips for Aligner Cutouts

• Due to the aligner’s high trimline you most likely won’t need to use an engager. If you want to use an engager with a cutout, then the engager should be attached on the same tooth or an adjacent tooth.
• The choice to use a button or a slit is mainly based on clinician preference.
• In order to achieve specific movements, additional anchorage is needed and therefore you may choose to use hooks or TADs. 
• To assist difficult movements such as root tip and space closure, elastics may be used with bonded hooks. You will need a different configuration for other movements.
• Always confirm the patient is not experiencing any unnecessary irritation due to the cutouts or presence of elastics.
• Always report any issue with your aligners to ClearCorrect’s Provider Services.

Protocols and Requesting Cutouts When Submitting a Case

ClearCorrect’s default protocol for Class II cutouts:

• Upper arch: Double slit cutout on canine on both sides of the arch
• Lower arch: Button cutout on first molar on mesial buccal side on both sides of the arch
• Starts on Step 1 through to the end of treatment 
• Cutouts will be always be placed on the buccal side
• Engagers will not be added on the same tooth with a button and/or slit cutout

ClearCorrect’s default protocol for Class III cutouts:

• Upper arch: Button cutout on first molar on mesial buccal side on both sides of the arch
• Lower arch: Double slit cutout on canine on both sides of the arch
• Starts on Step 1 through end of treatment 
• Cutouts will be always be placed on the buccal side
• No engagers will be added on same tooth with button and slit cutout

For both Class II and Class III cutouts, no ACS (Arch Correction Simulation) will be applied unless specifically requested by the clinician. 

Requesting cutouts:

Cutouts can be requested in the prescription form. Depending on the patient's bite classification or the dental conditions present, you will be prompted with an option to indicate if you will want cutouts and slits for elastics added to the treatment.

It is important to also include detailed instructions regarding the request for cutouts in the “Additional information” section of the case submission form.

If you would like to request custom cutouts in the aligners outside of the default protocols, you’ll need to communicate the following in your request for cutouts:

• The type of cutout that is needed (slit or button)
• The location of the cutout (the specific tooth/teeth and lingual/buccal)
• The type of correction being done (i.e., Class II, Class III correction, crossbite, intrusion/extrusion)

Note that ClearCorrect is not currently supporting the placement of button cutouts lingually in the anteriors (from canine to canine). Please make sure your request doesn't include this configuration. If your preference is to use elastics lingually, we recommend the use of slits on the anteriors (canine to canine).