Depending on how much space is required, space is created by extraction, arch expansion, or Interproximal Reduction (IPR). Regardless of all predictions and planning, there may be some cases where insufficient space may still be an issue. For example, when teeth are so crowded, they press up against each other and put each other under pressure. This pressure is relieved by creating space. Then the surrounding teeth may just move in to fill the space you’ve created. If this happens, you may need to create more space than originally planned. Otherwise the remaining movement will no longer have sufficient space, and treatment may go off track and the aligners no longer fit. In such cases more space is created by hand stripping/ Interproximal Reduction (IPR) or Case Revisions. Hand stripping - Needed space is created manually by using a diamond strip. Interproximal Reduction -The process of creating very small amounts of space between pairs of teeth in order to allow the teeth to move as needed during treatment. Case Revisions - patient's treatment is re-staged to target the original treatment goal, starting from the current position.
With a small amount of consistent pressure most teeth will move. But, some types of teeth, some movements, and some other factors may need more attention. These include, Maxillary laterals - Most of the time Maxillary Lateral Incisors have issues with rotations, extrusions, and intrusions. Short clinical crowns - In this case visible portion of the tooth don't protrude from the gums very much and because of that the teeth are simply too small to hold an aligner in position. Premolars Molars Patient’s age - The age limit for younger patients has to do with when the last permanent teeth erupt. Usually, this would be around age 13. Some older patients may need more time in comparison to a younger person due to slower metabolism, healing and tooth movement. Health of teeth - Tooth movement in clear aligner treatment involves complex biological mechanisms of bone and soft tissue inflammation and healing. These processes can be disrupted by poor oral hygiene resulting in harm to the patient (decalcification, recession, periodontal disease and gingival inflammation). Intrusions, Extrusions and Rotations - Rotations, extrusions and intrusions are some of the more difficult movements to achieve with clear aligners In such cases increasing pressure is achieved by: Force Amplifiers - Because of the shape and position of some teeth it may be difficult for an aligner to grab onto the teeth. In such cases small resin bumps are placed onto the facial surfaces of the teeth so that the aligner has something to grab on to. These resin bumps are called Force Amplifiers (Attachments). Overcorrection - It is continuing the movement of teeth in the same direction as originally planned with a little extra movement at the end of each treatment. Rotating with buttons - Turning a tooth around its long axis is called rotating. SureCure Aligners come with button cutouts as per the doctors prescription which allow for such movements.