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Clear aligner seCtion

the Invisalign aligners for Phase 2 treatment as part of a patient’s erupt, and arch expansion will help the teeth erupt normally, avoiding
multi-phase treatment plan? the need to make space later (especially to avoid bicuspid extractions),
Before we developed our multi-phase Invisalign treatment workflow, then also, we recommend an early intervention. Third, if the patient is
we thought that Phase 2 treatments with aligners might be very suffering from psychosocial factors related to the appearance of their
similar to using Invisalign for teens, since this had been the bulk teeth—for example, if they are being teased at school—then also early
of our previous experience for younger patients in the permanent orthodontic treatment is recommended.
dentition. Now that around 20-25% of our non-adult practice consists
of “multiphase” (Phase 1 and Phase 2) treatments (with the trend How do you manage treatment costs for two-phase orthodontic
going up), we have discovered that if you set up these patients for treatment?
success with aligners in Phase 1 to get their orthopedic foundation in The treatment cost difference between multi-phase and single-phase
place, then the orthodontic alignment part of their Phase 2 is much comprehensive treatment used to be the biggest barrier, because in the
more straightforward than trying to treat both the orthopedics and past, our patients were billed once for Phase 1 and then again for Phase
the dental alignment all at once. We do not have to spend extra time 2. Now I bill for a combined Phase 1 and Phase 2 treatment as a single-
undoing problems that are further complicated by waiting to address fee multi-phase treatment, which means that our patients have a much
them later. longer period of time (36-48 months typically) to make their payments
Additionally, by the time Phase 2 begins, the multi-phase patient compared to a single-phase teen treatment. This billing structure is
is already used to wearing Invisalign aligners, and they are familiar often easier for our families to manage financially, especially if they
with the steps of our Invisalign treatment workflow, so the process have multiple kids in orthodontic treatment at the same time. A single
of starting Phase 2 with aligners is a breeze. The patient has already multi-phase treatment fee also works well for our area because our
learned our digital treatment process at an early age, and the same patient demographic is relatively stable geographically, and families
process simply continues into their second phase. Now that we offer don’t relocate much for schools or job transfers. Unlike some regions,
Invisalign Virtual Appointments and Invisalign Virtual Care to assess we don’t have to worry about too many patients moving out of town
aligner fit throughout treatment, our aligner patients stay motivated or going elsewhere for their Phase 2 treatment. In areas where families
to wear their aligners, and this helps keep in-office visits limited to our tend to move around more, the fee model would probably have to be
scheduled visits. different.
Additionally, it is worth noting that when the treatment fees are
What are your tips for effective communication strategies with itemized by phases, parents tend to expect more to be accomplished
parents and patients concerning Phase 1 and Phase 2 treatment in the first phase, in hopes of avoiding a second phase, and this can
versus a single phase comprehensive treatment? lead to inefficiencies and even the occasional disappointment from
The first thing is just to articulate the goals and objectives for incorrect expectations. With the way we do things now, the parents
each phase of treatment. We describe Phase 1 to the parents as an know that we are offering the best solutions at the best time in
“orthopedic phase” where bone is being remodelled to gain space order to keep their kids engaged, and that we are seeking the best
and create symmetry, so that any orthopedic issues that could cause outcome possible over the course of a longer period of time. They
tooth damage or increase the risk of damage are intercepted. We then see that we have implemented technologies and tools like the iTero
explain that between Phase 1 and Phase 2 is a transitional period scanner for instant digital treatment simulations, and Invisalign™
where any remaining “baby” (primary) teeth fall out and any space Stickables aligner stickers so our younger patients can customize their
gained in Phase 1 needs to be maintained until the new permanent aligners and express their own personal style. We also have advanced
teeth erupt. Lastly, any final touches with respect to growth, the aligner treatment options available, like Invisalign treatment with
bite, and alignment for esthetics will be addressed during Phase 2. mandibular advancement for Class 2 correction. The integration of
Distinguishing the orthopedic phase (Phase 1) from the alignment Invisalign Virtual Appointments and Invisalign Virtual Care into
phase (Phase 2) helps our parents understand the importance of each our daily workflow also makes treatment much more convenient for
phase, and it also helps to avoid the blending of one phase into the ourpatients.
next without a clear break in between.
For our younger patients, we always try to identify three specific What are some examples of typical multi-phase treatment cases in
situations where early treatment with Phase 1 is advantageous over a your office with Invisalign aligners that you can share?
single-phase comprehensive treatment as a teenager. First, if teeth are The first case is a typical anterior dental crossbite case, where early
being damaged, or are at a high risk for damage, we do not want the intervention kept the incisors from wearing down prematurely.
patient to endure something irreversible that could have been easily Jumping the crossbite also allowed the permanent incisors to erupt
prevented. Protruded teeth, which are at a risk of fracture from trauma normally. Delaying the treatment would have taken a lot more work
to the face is a good example of high risk for damage. Incisal wear of to undo the flaring and crowding that would have occurred as a result
permanent teeth due to an anterior crossbite is another good example. of the negative overjet, and sometimes the lower incisor periodontal
Second, if enough space is not present for the permanent teeth to health is also compromised as a result of the flaring.
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38 Dental Practice i November-December 2023 i Vol 19 No 6