Frequently Asked Questions

• All aligners in a system can be applied to a single arch or both arches

• Our unlimited system is designed for cases requiring “a lot” of movement. This gives us the ability to address multiple different concerns with an unlimited number of aligners. Pre aligner therapy is recommended for cases where crowding required 4mm of lateral development.

• We understand not all Doctors or patients prefer the use of attachments. We offer the options in our prescription to indicate if you would like to utilize attachments for your case or not.
• Attachment placement is required for cases involving any rotations over 15 degrees, more than 0.5mm of intrusion or extrusion, and cases involving heavy tipping or torquing.

• We offer the options in our prescription to indicate if you would like to utilize IPR for your case or not.
• Please note, that there are certain case limitations that keep us from being able to provide setups with no IPR. Spacing on one arch with crowding on the opposing, no overjet, attaining or maintaining class I occlusion, etc.
• We may suggest the use of pre-aligner therapy prior to clear aligner therapy if no IPR is selected.

• We do not currently offer treatment plans for cases involving bite re-articulation, however, we can address minor bite adjustments utilizing tipping and up righting of posterior teeth.
• We can treatment plan your cases utilizing PAB and class II or class III elastics to shift the mandible into a more ideal position.

• Pontics are available to be placed in the aligner for an added charge. (please make sure to note the shade on the RX)
• Tooth shaped voids for composite are also available. This is a tooth-shaped void in the aligner for you to fill in office with composite. (Please make sure to note on the RX that you would like a composite shell/ void for the missing tooth).

• Retainers can be ordered at the time of your aligner order or you can order retainers after your patient has completed treatment
• It is at your discretion if you would like to send new scans after treatment for the retainer or if you would like us to fabricate the retainer off of the last digital models
• If your case is likely to require refinement it is recommended to order aligners after treatment is complete.
• The final aligner is contraindicated for wear over 4 weeks and does not serve as a permanent retainer.

• A completed RX filled out digitally through the SmileShare™ platform outlining your treatment objectives
• Models, impressions, or digital scans. Including the arch(s) being treated, opposing and bite registration
• Photos are not required but are helpful especially with midline shifts, etc
• Radiographs are also not required but are helpful for us in understanding your treatment objectives
• Additional resources may be requested depending on case difficulty

• PVS
• Polyether materials
• DYNAFLEX® DOES NOT ACCEPT ALGINATE AS IT DRIES OUT AND THE MATERIAL CAN SHRINK OR EXPAND DEPENDENT UPON ENVIRONMENTAL FACTORS. If alginate impressions are sent, they can be used for evaluation only. Once aligners are ordered, new silicone-based impressions will be required and additional fees will be applied for the additional setup of the case.
• All digital scans/ .STL files

• Make sure to use the proper size impression tray for the patient. If tray is too big or too small, it will affect the quality of the impression.
• Performing a cleaning prior to taking the impression will remove plaque or tartar buildup which can result in better impressions and less residual spacing at the end of treatment.
• Make sure you are following the instructions for the material exactly.
• Set a timer to make sure you are not removing the impression tray before the material is fully set. It is suggested to extend the time by 60-90 seconds to ensure the material is fully set.
• Make sure there is enough impression material in the tray to capture all of the patient’s dentition, including the distal of the last molars and the full facial of the central incisors.
• Remove archwires, molar bands, other appliances before taking the impression.
• Dry teeth with air syringe to eliminate saliva bubbles
• Make sure to check the impression before sending to the lab for the following:
  • All gingival margins are clear and defined
  • There are no imperfections in the impression (voids, bubbles, pulls, tears, drags, double impression/imprint, etc)
  • Make sure the anatomy is detailed and accurate
  • Make sure that the impression is not damaged
  • Make sure the material is not too thin (most common area is on the facial of the central incisors)

• Bubbles/voids
  • Bubbles occur as a result of fluid accumulation or air entrapment.
  • Can also be caused by insufficient amount of impression material
• Pulls/drags
  • Drags occur when long, rounded depressions that resemble the cuspal edges of the teeth are left in the impression material upon insertion of the tray.
  • Pulls occur when a fold is created in the material (usually around gingival third)
  • Both can occur for the following reasons:
    • Impression material being used beyond its working time (It is no longer in its most fluid state)
    • Impression material did not properly adapt to the teeth
    • Insertion of the impression tray in one motion.
    • Teeth rebounding off the tray and sliding into position
    • Common when using more viscous impression material (heavy body only)
    • To avoid drags and pulls…
      • Syringe a less viscous/light body material around the teeth or placed over the more viscous material in the tray prior to insertion
      • Avoid contact between the tray and the teeth
      • Make sure dentition is dry to avoid fluid accumulation.
      • Seat the tray gradually from anterior to posterior or vice versa to allow the air to escape as the tray is seated.
    • Improper Tray Selection
      • Tray should be large enough to encompass all the teeth without contacting the soft tissue.
      • Tray should not be visible through the impression material in the completed impression. This indicates the tray was either too small or positioned incorrectly.
    • Scans
      • Visible artifacts obstructing teeth
      • Un-captured areas requiring treatment

• Please make sure to thoroughly check the impressions before sending to ensure they are free from any defects or deformities.
• Fill out an RX in SmileShare 
• Place impressions in the box with the filled out RX (can print from SmileShare once entered) and ship them directly to the lab. – Contact if you need DynaFlex boxes
• All models must be bubble wrapped
• Add 2-3 days to your turnaround time

• More comfortable than physical impressions
• No shipping costs or hassles or delays
• If taken properly, the scans have higher accuracy and fewer errors than physical impressions.
• Many scanners can be set up to send directly to DynaFlex® saving you time
• .STL files can be attached directly to your SmileShare RX

• Scan both arches even if treating only one arch. Based on the type of movement requested, many times the opposing arch is needed to check occlusion or we may suggest one of our systems for cost savings.
• To prevent aligners from flaring or becoming thin at the edges, always capture at least 3-5mm of the gum tissue in the scan
• Always inspect the .stl files before sending to check for holes, artifacts, stitching errors (double image of the teeth) etc
• If an EZ-X appliance is requested, make sure to include the full palate in the scan
• Include as much of the occlusion as your scanner allows to capture a more accurate bite scan.

• If your scanner is set up to automatically send your .stl files to DynaFlex®, you will just need to make sure to fill out your prescription in SmileShare
• If your scanner does not automatically connect to the lab, you can contact our 3D department at 1-800-489-4020 ext 3002 to get set up.
• It is IMPERATIVE to always submit an RX or the scans will not be pulled from the database
• You can also download .STL files from your scanner and attach directly to your prescription

• With each case you will receive the following:
  • Doctor instructions for use
  • Patient instructions for use
  • An IPR card showing suggested areas for interproximal reduction ***IPR is to be performed at Doctor’s discretion***
  • Aligners laser marked with the case number, arch, and number sequence
  • Aligners bagged in order and labeled with the number in the sequence
  • Emery board to smooth any edges that may cause irritation
  • Aligner case to keep the aligners safe while the patient is eating and brushing, etc
  • Aligner removal tool to aid the patient in easily removing the aligners without putting additional stress on the material
  • Chewies to be utilized during delivery of the aligners
  • Aligner smoothing tool- emery board
  • Occasionally, there will also be a card from our technicians with useful information pertaining to the case.
• Check the IPR card that came with the case and evaluate the patient to see if any IPR is needed prior to delivering the first aligner. Please keep in mind, the teeth need space to move efficiently. If the contacts are too tight or crowded, additional pressure will be put on the teeth and the teeth will not move as intended.
• If attachments are included in the treatment plan, use the provided template aligner to bond the attachments
• Seat the first aligner in office to ensure fit and comfort. If there are fit or comfort issues, the patient is more likely to be non-compliant.
• Use your discretion to determine how many of the aligners you wish to deliver to the patient at a time based on how often you want to monitor the patient’s progress

• Please keep in mind that the first aligner includes movement so the fit will not be exact however the aligner should still seat appropriately.
• Aligner is too big
  • Aligner is too wide or too long for the patient’s arch
  • Aligner does not stay in place when the patient opens their mouth or speaks
  • This can be caused by minor distortions in the impressions, arch expansion was not completed as expected, or the molars not distalizing as expected.
• Aligner is too small
  • Aligner can’t be easily placed into the patient’s mouth.
  • If you have to trim or forcibly seat the aligner, it is likely too small and best to contact the lab.
  • Some causes for this include: Undesirable undercuts resulting in too much retention, bulbous teeth, excessive crowding resulting in too much retention, mesial movements did not occur as planned, lingual movements did not occur as planned.
• Rocking
  • Aligner rocks from side to side
  • Aligner fits one side but not the other
• The side that is tracking correctly fits flush but the side that is not tracking properly will not seat at all
• Rocking can be caused by minor distortions in the impressions, a lack of retention, tracking issues, arch has not expanded as expected, distalization of the molars has not occurred as planned.
• Some less common causes are exposure to high temperatures resulting distortion of the aligner or the patient has had restorative work done
• Incisal Gaps
  • An incisal gap is a gap that occurs between the incisal edge of the tooth and the aligner.
  • Generally, there will be a build up of saliva bubbles in an incisal gap.
  • Incisal gaps can be caused by a number of reasons including: patient non-compliance, patient’s current wear schedule is not enough and needs to be extended, tooth movements (extrusion, rotations, intrusion, torque, tip, etc) not occurring as planned due to insufficient space or insufficient pressure from the aligner, aligner will not seat over attachments.

• Backtracking (Educate your patient to always keep their previous aligners until treatment is complete)
  • Reasons for backtracking include:
    • Aligners not seating
    • Aligners worsening in fit gradually
    • Gap between incisal edge and the aligner tray
    • Aligners too tight to fully seat
    • Patient non-compliance
    • If patient lost or broke their aligner. Order a replacement and have them backtrack to previous aligner until delivery.
  • How to backtrack:
    • For example, if patient is having fit issues with tray #9 of 10
      1. Have the patient return with their box of their previous aligners they have worn and saved. (If patient did not save their previous aligners, you may need to reorder from the lab)
      2. Starting with the patient’s current aligner, have them first try the previous aligner in the series (ex #8)
      3. If the previous aligner (#8) also does not fit, try the aligner prior to that one (ex #7)
      4. Repeat this process until you find an aligner that seats well and fits properly without incisal gaps. (For example, for this case patient had to backtrack to aligner #7). If you do not find an aligner that fits well, you may need to do a revision with new impressions/scans.
      5. Have the patient wear the fitting aligner (ex #7) for the suggested wear time 22 hours per day for 7-10 days.
      6. Then have patient move to the next aligner in the series (ex #8) and progress through the series until treatment is finished as long as there are no further issues with fit.
    • Using Chewies or cotton rolls to help the aligners seat properly.
    • Either requesting the distal half of the aligner to be trimmed when you submit the case or trimming the distal half of the aligner in office.
    • May need to perform additional IPR
    • Look for impression distortions from the original impression to pinpoint where the issue occurred from.
    • If chewies or backtracking do not work, you may need to request a revision from the lab. New impressions may be necessary if this is the case.
    • Check the treatment plan to see if non-compliance is an issue
    • Check treatment plan to see if planned extrusion or intrusion is not occurring, causing incisal gaps. May need to request a revision to include attachments. We will suggest attachments for all cases requiring over 0.5mm of intrusion/extrusion.
    • Check for contraindications such as short clinical crowns, multiple missing teeth, second molars that have not fully erupted, poor oral hygiene, severe bruxism, active periodontal disease, dental prosthetics or implants.
    • If the above did not provide desired results, rescan/reimpress for midcourse correction

• • What are tracking issues?
    • Tracking describes how SmileShare™ clear aligners move the patient’s teeth according to the approved treatment plan.
    • Even if the aligners appear to fit properly that does not guarantee that the teeth are moving according to the specified treatment plan.
  • What are some causes of tracking issues?
    • Insufficient pressure provided by the aligner (aligner ran out of energy)
    • Insufficient space (some IPR needs to be performed)
    • Non-compliance by the patient
    • Tooth Shape
    • Type of tooth movement (some are more predictable than others.
  • Tips and tricks identify tracking issues before the treatment plan goes too far off track:
  • If there are fit issues upon the delivery of the aligner but the patient calls a few days later to say the fit is resolved, do not rely on self-assessment by the patient. Schedule a follow-up visit to confirm the fit before moving to the next aligner in the sequence.
  • If the patient is non-compliant, make sure that you are educating them to wear their aligners at least 22 hours per day for approximately 7-10 days. Aligners are only to be removed for eating and brushing. Some signs of non-compliance include tight-fitting aligner after the specified time-frame, unusually clean aligners, and missed appointments. Patient should contact the office immediately if there are issues with fit or if the aligner has become lost or broken.
  • If you notice saliva build-up or bubbles between the incisal edge of the tooth and the aligner, this indicates that there is a significant gap in between the tray and the tooth.
  • Solutions:
  • Backtracking (Educate your patient to always keep their previous aligners until treatment is complete)
    • Reasons for backtracking include:
      • Aligners not seating
      • Aligners worsening in fit gradually
      • Gap between incisal edge and the aligner tray
      • Aligners too tight to fully seat
      • Patient non-compliance
      • If patient lost or broke their aligner. Order a replacement and have them backtrack to previous aligner until delivery.
    • How to backtrack:
      • For example, if patient is having fit issues with tray #9 of 10
        1. Have the patient return with their box of their previous aligners they have worn and saved. (If patient did not save their previous aligners, you may need to reorder from the lab)
        2. Starting with the patient’s current aligner, have them first try the previous aligner in the series (ex #8)
        3. If the previous aligner (#8) also does not fit, try the aligner prior to that one (ex #7)
        4. Repeat this process until you find an aligner that seats well and fits properly without incisal gaps. (For example, for this case patient had to backtrack to aligner #7). If you do not find an aligner that fits well, you may need to do a revision with new impressions/scans.
        5. Have the patient wear the fitting aligner (ex #7) for the suggested wear time 22 hours per day for 7-10 days.
        6. Then have patient move to the next aligner in the series (ex #8) and progress through the series until treatment is finished as long as there are no further issues with fit.
      • If teeth are not tracking correctly, some IPR may need to be performed in that area to create the necessary space.
      • Schedule regular appointments to monitor the patient’s progress.
      • Make sure that you regularly monitor the patient’s contacts throughout treatment to ensure there is adequate space for the teeth to move. Perform IPR in small increments as necessary.
      • Order additional final aligners if the tray ran out of energy and is no longer providing adequate pressure to finish the treatment plan
      • Order refinement aligners to finish the case according to the original treatment plan. Request overcorrection if a tooth is not moving according to plan.

  What is refinement and is it necessary?

  • Refinement is necessary when additional movement needed after the completion of a SmileShare aligner system. If your case was designed to completion your refinement aligners will cost $30/ aligner. If you opted for less aligners or waved the suggested treatment your case will be reevaluated for a new SmileShare system. Please see terms and conditions for additional info regarding refinement
  • All refinement aligners are included with the unlimited system
  • It is recommended for your office to include a buffer in your treatment fee in the case that refinement is needed.

• Residual spacing refers to the unintended spaces left after the completion of the treatment plan.
• What are some causes of residual spacing:
  • Too much IPR was performed that was not adequately closed with treatment
  • Patient’s bone biology or anatomy
  • Patient was non-compliant and did not wear the aligners for the recommended time of 22 hours per day for 7-10 days per aligner
  • Treatment plan included residual spacing due to a tooth-size discrepancy, anterior space closure without sufficient overjet, etc (this would have been noted to you in the treatment review or via phone call)
• Solutions:
  • Order refinement aligners to close the residual spacing. This option provides the most control over the space closure.
  • Order a Hawley type retainer to close anterior spaces.
  • Order a wrap-around type of retainer to close posterior spaces.
  • On future treatment plans, you can request overcorrection/digital power chain to overclose the contacts to ensure there are no spaces at the end of treatment.

For more help with SmileShare™, please visit the SmileShare™ tutorials page here