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serve  :  live  : smile

Marlon Moldez, DMD, MS, MSc, PhD

Orthodontists create treatment sequences to align the teeth and correct the bite through software programs designed to fabricate a series of aligners through digital printing. According to a prospective follow-up study, aligners are programmed to exert a pushing force to align teeth with a mean accuracy rate of 50%. Therefore, orthodontists must incorporate refinement aligners to achieve 100% correction.

Patients undergoing aligner therapy must fully seat the aligners into the dental arch (by biting chewies) and faithfully wear the aligners 22 hours per day to achieve at least 50% correction. Tooth mobility is excessive, or tooth movement is incomplete if the patient switches to the next aligner too quickly (i.e., less than seven days). In addition, chronic clenching can result in the deformation of aligners, which, in turn, amplifies tooth alignment inaccuracies.

Like other orthodontic treatments, clear aligner therapy is a collaborative effort between the doctor and the patient. The doctor plans and supervises treatment, but the treatment outcome depends on patient performance. Excessive refinements may indicate poor patient compliance, persistent parafunctional oral habits, or inherent aligner inaccuracies.

Marlon A. Moldez, DMD, MS, MSc, PhD

If the patient has poor oral hygiene, gingivitis, enamel demineralization (white spot lesions), and tooth cavities are likely. Because tooth-whitening agents can exacerbate these conditions, patients must first restore the health of the teeth and gums and maintain optimal oral health for at least 4-8 weeks before scheduling a tooth-whitening procedure after orthodontic treatment. With meticulous cleaning (tooth brushing) and plaque control by your dentist or oral hygienist, the gums naturally heal, and the enamel remineralizes from the action of calcium and phosphate in saliva.

Marlon A. Moldez, DMD, MS, MSc, PhD

Gingival aesthetics play a large role in the visual assessment of a finished orthodontic case. Excessive gingival display, uneven gingival contours, and disproportionate crown heights and widths as a result of less than ideal gingival anatomy significantly diminish the aesthetic value of even the most perfectly aligned teeth.

Ideally, the gingival margins of the upper anterior teeth are positioned at or very near the inferior border of the upper lip in full smile. Display of gingival tissue in excess of 2 mm is generally considered to be undesirable. Additionally, the position, contour, and bulk of the gingiva on the crowns of the teeth often determine the perception of tooth length and width, with uneven gingival contours causing some teeth to appear too short while others appear too tall. The gingival margins of the upper central incisors and upper cuspids should be approximately level with each other and slightly superior to the gingival margins of the upper lateral incisors. The gingival zeniths of the upper lateral incisors should typically coincide with their long axis centers, and gingival symmetry should exist from one side to the other

With the advent of diode laser many clinicians are choosing to include optimization of gingival aesthetics as part of comprehensive orthodontic treatment. As a rule, aesthetic gingival recontouring is most beneficial in the upper arch from cuspid to cuspid.


Graber, LW et. al., Orthodontics: Current Principles and Techniques, 5th ed, 2011).


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