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Materials and instruments needed for slit cutouts: 

	Aligner slit punch plier
	Elastic band
	Clear aligner

For slit cutouts for Class II correction refer to the following:

1. Modify the upper aligner(s) to prepare for using elastics with slit cutouts in the aligner:

Use an aligner slit punch plier to create a double slit cutout on the gingival margin above upper canines and where the elastic will attach.

 Double Slit Cutout above Upper Arch Canine

2. Modify the lower aligner to prepare for using elastics with slit cutouts in the aligner:

Use an aligner slit punch plier to create a double slit cutout on the gingival margin below the molars.

 Double Slit Cutout below Lower Arch First Molar

3. Elastic placement: 

Insert the aligner and pull the elastic over the piece of gingival margin between the two slits above the canines. Then stretch the elastic and pull it over the gingival margin between the two slits beneath the lower molars.

Slit to Slit Cutout

4. Carefully monitor the progress of the correction at each appointment.

The elastic is worn until the Class II malocclusion is corrected or slightly overcorrected. Overcorrection can be planned in the treatment setup as well to prevent relapse.

For slit cutouts for Class III correction refer to the following:

1. Modify the upper aligner(s) to prepare for using elastics with slit cutouts in the aligner:

Use an aligner slit punch plier to create a double slit cutout on the gingival margin above upper molars and where the elastic will attach.

 Double Slit Cutout above Upper Arch First Molar

2. Modify the lower aligner to prepare for using elastics with slit cutouts in the aligner:

Use an aligner slit punch plier to create a double slit cutout on the gingival margin below the canines.

 Double Slit Cutout below Lower Arch Canine

3. Elastic placement: 

Insert the aligner and pull the elastic over the piece of gingival margin between the two slits above the molars. Then stretch the elastic and pull it over the gingival margin between the two slits beneath the lower canines.

Slit to Slit Cutout

4. Carefully monitor the progress of the correction at each appointment.

The elastic is worn until the Class III malocclusion is corrected or slightly overcorrected. Overcorrection can be planned in the treatment setup as well to prevent relapse.

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