When you’re an orthodontic provider, there comes a time in certain patient cases where you have to determine if particular individuals are or are not candidates for the type of treatment they’re asking for; particularly if it’s clear aligners.
Because removable aligners rely on different mechanisms of pressure and tooth movement to work properly, there are bound to be situations where a patient cannot pursue this avenue of treatment. It’s up to you as an educated provider to determine if this is the case…as well as how to break the bad news to your patient.

Your Experience as an Orthodontic Provider

From new orthodontic providers to more experienced specialists, there will always be cases where you feel uncertain or have a gut response about how you need to proceed with treatment. Strong willed patients that want a specific type of braces may make this decision process even more challenging to work through.

Although clear alignment technology has expanded the situations that can be corrected, there remain several concerns that may contraindicate treatment. Some of the most common, include:

• Inadequate crown height
• Unerupted 2nd molars
• Fixed dental prosthetics, such as bridges
• The presence of dental implants
• Chronic grinding/clenching habits
• Crowding or gaps with spaces that need to be moved more than 6mm
• More than 3-4mm of an overjet, overbite, or midline discrepancy
• The presence of an open bite

While minor variations of these conditions can be treated with removable aligners, most of the time they will need to be addressed by an expert. If you have experience with easier or more moderate variations, then it may be an easier decision to make when it comes to initiating treatment. Otherwise, it’s suggested to get a second opinion or recommend another type of orthodontic therapy.

Getting a Second Opinion

What happens when you’re torn between starting treatment or saying “no”? Thanks to CephX’s innovative AlgoCeph technology, your patient’s cephalometric radiograph can be traced and analyzed with seconds and provide you with measurements and recommendations before the patient ever leaves the office.

This efficient, cloud based process allows you to quickly access cephalometric analysis, cephalometric superimposition, profile overlay and other features – all within seconds.

Reviewing the Treatment Plan

Patients tend to be more receptive to treatment recommendations when they’re educated about the pros and cons of other alternatives. It’s not just your job to tell them when clear aligners aren’t an option; it’s your duty to tell them why. Otherwise, they’re apt to “doctor hop” until they find an orthodontist that will say ok to the treatment, even if they know it’s not appropriate. When you educate, you show how much you care about the wellbeing of your patients. Not only does this earn the respect of your prospective patients, it adds quality and value to the services you offer in your practice.

The Patient’s Perspective

It’s hard to let something go, especially when you’ve had your heart set on it for a long time. For an adult to consider getting braces, sometimes it means they’re only willing to move forward with treatment if they can have a particular type of braces. Usually, that means clear aligners. It’s up to you to decide if their goals can be met, or another option is more appropriate.

The Ultimatum

There’s a lot of psychology that comes into play when you need to convince a patient that it’s better to have traditional braces or no treatment at all. Because you know the likely outcome, it’s up to you to explain to the patient that it isn’t worth pursuing a clear alignment tray system. The key is to point out the major factors involved in their decision to get treatment:

Money —Usually, a person will be paying more for clear aligners than they would with a conventional option. For the achievable results, is it going to be worth the investment…especially if you’re not able to reach them? Make it clear that even after paying for a full course of treatment, there may still be remaining alignment needs, disqualifying the effectiveness of this particular method or even doubling the total cost of their orthodontic therapy.

Time — All of those trips to the office, the maintenance at home, and cleaning your aligners…is it worth it? A traditional system would be able to move the teeth more efficiently, allowing your patients to complete treatment sooner and in fewer appointments. When it comes down to taking time off of work and paying for treatment, conventional braces may be more cost effective from every standpoint.

Aesthetics — What is your patient’s primary goal of treatment? Do they want a particular tooth moved? If you can’t make that happen with clear aligners, but could do it precisely with a strategically placed bracket, the trade-off should be worth it. Knowing what the end results will be — as opposed to guessing what they will be — should be enough to convince the patient of the best treatment.

Health — Correcting the alignment and occlusion of the teeth and jaws will be beneficial to long-term health and function. Explain the risk factors of allowing the condition to go uncorrected, vs. what complications could occur if alignment was attempted with a removable system.

Making Other Treatments Feel More Inviting

Because aesthetics is often the tilting point between traditional and clear braces, it’s vital to take advantage of discussing realistic options that can help. Ceramic brackets and low-profile arch wires should be kept on hand to show your patient — in person — what they look like. Once they’ve seen how cosmetically appealing they really are, your patients will be more open to the idea of traditional systems. Suddenly, the idea of “all or nothing” doesn’t seem quite so bad.

As an orthodontic provider, it’s your responsibility to only render services that will improve or maintain your patients’ oral health. When that means saying “no” to a particular treatment, you can know you’re doing the right thing.