Excellence Symposium Take Home Message

Interdisciplinary management of complex cases like deep bite correction requires a unified treatment strategy between the general practitioner, orthodontist, and prosthodontist. Digital workflows play a key role in facilitating this collaboration—platforms such as SmileCloud allow all parties to visualise the treatment objectives, co-plan cases, and align on diagnostic and aesthetic parameters from the outset. Shared digital setups and dynamic 3D treatment simulations ensure that tooth movements, restorative space planning, and occlusal goals are coordinated in real time. This integrated approach can enhances communication, reduce the risk of errors, and result in more predictable and efficient outcomes for the patient.

In cases with deep bites or worn dentition, durable, semi-permanent composite restorations can be used as provisionals to test the new occlusion during aligner treatment. These provisionals allow clinicians to evaluate how the patient’s bite adapts and to monitor for any wear or chipping. This feedback is invaluable for making timely adjustments to both the orthodontic treatment plan and the prosthodontic restoration plan, ensuring optimal function and aesthetics. Careful aligner design and regular review help protect these restorations throughout the treatment.

In periodontally compromised patients, aligner treatment must prioritise biological safety. This involves applying lighter, well-distributed forces—ideally with a reduced rate of movement (e.g., 0.2 mm or 2 degrees per step)—and extending the aligner wear cycle to up to three weeks, depending on individual response. Treatment should only begin after active periodontal disease is stabilised, ideally in consultation with a periodontist, who can help assess feasible movements based on bone and attachment levels. Anchorage is managed by staging movements carefully and avoiding unnecessary engagers; ClearCorrect’s high trimline aids in force control without overloading vulnerable teeth. Ongoing periodontal maintenance and interdisciplinary monitoring throughout treatment are essential to ensure long-term stability and minimise the risk of further attachment loss.

Skeletal discrepancies, particularly asymmetrical cases, are inherently complex to manage with aligners alone and necessitate meticulous, advanced planning. A highly individualised approach is essential, with Temporary Anchorage Devices (TADs) placed strategically to manage asymmetrical force systems while preserving periodontal health.

Precise vector control is critical; TADs must provide stable anchorage that enables the delivery of targeted forces to achieve the intended corrections without inducing unintended tooth movements. The integration of aligners programmed for sequential movement, alongside TAD-supported elastics, allows for controlled correction across multiple planes. Digital treatment planning tools are instrumental in identifying skeletal asymmetries, forecasting outcomes, and guiding biomechanical decisions. Due to the evolving nature of such discrepancies, continuous monitoring and timely adjustments are crucial to ensure effective and stable results.

Ensuring occlusal stability after orthognathic surgery with aligners involves careful sequencing of tooth movements and timely use of elastics to promote proper intercuspation. Retention protocols include staged refinements targeting posterior occlusion to close any residual open bites. Controlling the vertical dimension through auxiliary mechanics and selective intrusion or extrusion of posterior teeth helps prevent relapse. Close collaboration between the surgeon and orthodontist, alongside patient compliance in wearing elastics and retainers, is essential for maintaining a stable and functional occlusion.

TMD management should begin with a thorough diagnostic workup, including joint evaluation, range of motion testing, and imaging if needed. Initial treatment often includes a stabilisation splint to reduce muscle hyperactivity and realign the joint. Botox injections can be used adjunctively to reduce masseter overactivity, particularly in cases of bruxism or myofascial pain, providing temporary relief and improving splint or aligner tolerance. Once symptoms stabilise, aligners can be carefully introduced with minor tooth movements and monitored closely for any symptom recurrence.

Whether to offer records collection and intra-oral scans as a complimentary or paid service should be guided by the practice’s broader strategic objectives and patient experience model. Providing these services free of charge can serve as an effective tool to enhance case acceptance, particularly when integrated into a structured consultation that includes visual treatment simulations. It is important to ensure the entire team is aligned with the practice’s workflow and communication strategy, as a cohesive approach significantly improves patient engagement. Additionally, structured follow-up with patients who do not proceed immediately is key to maintaining interest and supporting future conversions.