10 Tips and Tricks With Clear Aligners

to use with
INTRODUCTION
I started using clear aligners in 2004. At that
time, you almost had to be a little crazy (I
was!) to decide to treat patients and move
teeth with "plastic." One thing is for sure:
you had to be confident and learn fast how
to think like plastic!
Go back to 2004: there was no social media,

no Bluetooth, no iPhone, iPad, no YouTube,
and no Twitter. Netflix was a company where
you could rent VHS cassettes... delivered by
mail! (that's it; I feel old now). BTW, if you
don't know what a VHS cassette is... I hate
you! 😉
I fell in love really fast with the product. I

could see the benefits it brought to my
patients and the excitement in the eyes of
my team.
During these years, using clear aligners, I

developed tips and tricks through my
successes... and failures. And I am happy to
share 10 of them in this book.
Enjoy and have fun Making the MOVE!
Stephane Reinhardt, DMD

Director Education Program / Educator
The CLEAR Institute Inc.
© 2023 The CLEAR Institute Inc. All rights reserved

03
CONTENT
Tip #1 - P. C. S. page 4
Tip #2 - Give options page 5
Tip #3 - Understand what you see page 6
Tip #4 - Understand mechanics page 7
Tip #5 - Vertical meets horizontal page 8
Tip #6 - When in doubt... page 9
Tip #7 - Size matters page 10
Tip #8 - Position matters page 11
Tip #9 - To IPR or not to IPR? page 12
Tip #10 - Repeat, repeat, repeat page 13
Bonus tip page 14
Links page 16
Testimonials page 17

04
TIP #1: P.C.S.

When you see a patient in consultation, and
you see that they would benefit from a clear
aligner treatment, DO NOT TALK ABOUT IT
before they truly understand the problem.
Too often, we start by giving our patients the

SOLUTION before they even understand that
they have a problem.
We should always start with explaining the

PROBLEMS first, then explain what the
CONSEQUENCES of that PROBLEM are, and
finally, once they understand and they OWN
the problem (it is not YOUR problem!), then
we can talk about the SOLUTION. And it is
not clear aligners!
The solution is to move the teeth and bring

them back in the right functional position so
they can close properly together. And for
that, we will use clear aligners.
Clear aligners are the tools we use, and they

are not the solution.
Example: "Mrs. Smith, your teeth are not

closing properly together (PROBLEM). Therefore
they are wearing out (CONSEQUENCE). To stop
the process and avoid future problems, I
suggest moving them in the right position."

05
TIP #2: GIVE OPTIONS

Give options to your patients. People like to
choose. Ideally, every time you propose a
treatment plan, you should have 3 options.
It's important to use the right words. We give

options or alternative treatments. Not
compromised treatments.
The first option is simple: it's always "Do

nothing."
The second option is the ideal treatment that

the patient should do. The "textbook"
treatment. For example, an adult patient with
a class III skeletal and dental relation would
need orthodontic treatment with an
orthognathic surgery to be featured on the
cover of an orthodontic reference book.
The third option for this patient would be to

keep the class III skeletal relation and treat
only the teeth.
Everything is possible. The important is to

inform the patients and give them enough
information for them to make the right
decision.

06
TIP #3: UNDERSTAND WHAT YOU SEE

No matter what system you use (ex.
Invisalign), you must understand the software
you use to set up your treatment.
It is important to make the difference

between what the technicians (or the
software AI, or a combination of both) will
send you "the setup" and what you will do
with it "the treatment plan."
There is a difference between both. You know

your patient. You know your case. You are the
dentist. YOU are the one responsible, and you
need to be in control.
When you look at a virtual setup, even if you

see teeth that are moving, you actually see a
force system. You are looking at how the
force will be applied to the teeth.
It is sometimes counterintuitive, and you may

need to make a paradigm shift. But this is
where you will do most of the work and all
the time you will spend on the software (ex.
ClinCheck software for Invisalign) will be all
the time you will gain in the overall
treatment.
Don't let the software decide for you!

07
TIP #4: UNDERSTAND MECHANICS

When using clear aligners, we must
remember that we are actually doing
orthodontics.
We sometimes hear: "We will do an Invisalign

treatment for Mrs. Smith." When actually,
what you will do is an orthodontic treatment
for Mrs. Smith, and Invisalign is the tool or
the appliance you will use to do it.
To understand orthodontics, to understand

what you are doing, you need to understand
mechanics.
Tip, torque, center of resistance, center of

rotation, moments of force, couples,
moments of couples, and translation, are all
concepts we must understand.
It is not always easy to master these

concepts, but it can be done. And it makes all
the difference when planning a case or when
trying to understand when things do not go
as planned. And I am not saying "if things..."
but "when things...".
The only way to ensure you will never have

problems with clear aligners is to decide not
to use them!

08
TIP #5: VERTICAL MEETS HORIZONTAL

One of the most useful tricks to remember
when you are planning your mechanics and
your movements on the software, is to think
of how the direction of the forces will be
oriented compared to the position of the
teeth.
For example, if you want to extrude a tooth,

the force will be vertical. Same thing if you
want to intrude a tooth. If you want to rotate
a tooth, the force will be horizontal.
To be efficient, we need a surface where we

will apply the force. Because of the
morphology of the teeth, we do not always
have a sufficient surface where we can apply
the force.
This is where we need to add attachments.

But how should we orient the attachments?
The best way to remember it is to have the

surface of the attachment where the force
will be applied perpendicular to the force
vector you will apply.
In other words, a vertical force will need a

horizontal attachment and a horizontal force
will need a vertical attachment.

09
TIP # 6: WHEN IN DOUBT...

One of the most popular questions I receive
is:
"Should I put an attachment on this tooth?"
When in doubt, put an attachment. You will

never be in trouble because you put an
attachment on a tooth that doesn't really
need one.
On the other hand, if you remove

attachments where they are needed, you are
compromising the success of the treatment.
When the software puts an attachment on a

tooth, it usually needs an attachment. If you
decide to remove it, it should be to change it
for another type of attachment.
Don't listen to your patients who want to

dictate treatment to you. "I don't want
attachments on the anterior teeth" they will
sometimes say. This can lead to movements
not happening. And guess who will complain
that the teeth are not straight?
What is the limit to the number of

attachments we can add to a case of clear
aligners? It can be an attachment on every
tooth. Just make sure your patients can
remove the aligners!

10
TIP #7: SIZE MATTERS

It's all about the surface! The first principle
to understand with clear aligners is that they
push on teeth. They do not pull.
Since they are pushing, the surface where the

force will be applied becomes important. A
tooth with a small surface will be harder to
move than a tooth with a big surface.
One of the ways we can help movement

happen is by adding attachments to the
teeth. Regarding attachments, we can choose
the size, length and thickness.
Since the force will be applied to these

attachments, it is essential to have them as
long and thick as possible.
Why would you put a 3mm attachment on a

tooth that can take a 5mm attachment? You
will almost double the size where the force
will be applied!
If you work with Invisalign, you can use

conventional rectangular attachments (size 3,
4 or 5mm) or optimized attachments (OA).
When choosing OA, go into your clinical

preferences, and choose the largest that fits.

11
TIP #8: POSITION MATTERS

I will never stress enough how attachments
are essential and contribute to the success of
treatments with clear aligners.
Another thing I constantly repeat when I

lecture is: THINK LIKE PLASTIC!
Take an aligner in your hand, no matter the

brand. If you manipulate it, you will see that
the more you go towards the incisal or
occlusal, the stiffer they get.
If you think like plastic, you would probably

prefer to grip yourself on an attachment at
the stiffest part of the aligner. This should
dictate where you will put the attachments
on the teeth. If the region where the aligner
is stiff grabs the attachment, you have a
better chance that the force will be applied
efficiently.
This is why I prefer to have my attachments

in the incisal or occlusal third of the teeth.
And not near the gingival like we see too
often. The limit should be the maximum
convexity of the teeth.
Using the biggest attachments possible in

the correct orientation will help you avoid
frustration with teeth not tracking.

12
TIP #9: TO IPR OR NOT TO IPR

Who is afraid of IPR? Maybe you are. I am not
because I am aware of studies and scientific
literature proving that we do not harm
patients when performing IPR. But if I can do
a case without IPR, I will prefer that.
We plan IPR because we need space. If you

decide to plan your cases without IPR, you
will have to find another way to create the
space you need.
Options are:
Expanding
Proclining
Distalizing
Extraction
There is not only one good way to do things;

otherwise, we would all do the same thing.
It's important to know that if you are
comfortable with IPR, you should decide
where and when to do it. Once more: NOT
THE SOFTWARE!
You have to plan the IPR when you have

good access between the teeth. Sometimes
the software will plan IPR where teeth are
overlapping. You have to change it and
communicate when you want to do it during
the treatment.

13
TIP #10: REPEAT, REPEAT, REPEAT

We spend a lot of time explaining our
treatments to our patients.
We spend a lot of time explaining our

informed consent to our patients.
We spend a lot of time explaining that they

will need retention at the end of their
orthodontic treatment.
We spend a lot of time explaining that they

will have to wear the aligners for 21 to 22
hours daily.
We spend a lot of time explaining the

importance of treating them because they are
wearing out their teeth.
The reality is... they forget!
We think what we told them 6 months ago is

still fresh in their head.
The reality is... they will remember maybe

10% of what we tell them when they are in
the dental chair.
This is why you and your team have to

repeat, repeat, repeat. All the time. (now
read this page one more time 😉).

14
BONUS TIP
Get educated! In this era of popularity where
AI seems to slowly take control of
everything, resist and don't rely on the
software to "do the job" and decide for you.
It is there to help, for sure. It is a great tool
that allows us to better treatment plan our
cases. But tell yourself that the software and
the technicians working on the "setup" are
not dentists. They are not diagnosing and
treatment planning your cases.
You have to spend time learning how clear

aligners work. You have to think like plastic!
You have to understand orthodontics. I am
not saying it is easy, but it can be learned.
There is no reason why you should not be as

comfortable using clear aligners in your
practice as you are with any other type of
treatment you already offer.
It is time to stop separating orthodontics and

the rest of what we do. It is time, now more
than ever, to Make the MOVE!
The CLEAR Institute is there to help you

learn, understand, use, integrate and master
clear aligners.

15
Depending on the level of knowledge and

confidence you have with clear aligners,
depending on your experience using these
tools and providing orthodontic treatments
to your patients, you will find on The CLEAR
Institute's online learning platform the
courses, programs and services that will
answer your needs.
Everything is in place for you to become a

leader in clear aligner treatments. And as
your education partner, we want to be part of
and witness your success.
Have fun Making the MOVE!
Stephane Reinhardt, DMD

Director Education Program / Educator
The CLEAR Institute Inc.

16
LINKS
LEARNING PROGRAMS
COURSES
LIVE COURSES
PRIVATE CONSULTATION
WEBSITE
BLOG
YOUTUBE CHANNEL
FACEBOOK
INSTAGRAM
LINKEDIN

17

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to use with

Go back to 2004: there was no social media,

I fell in love really fast with the product. I

During these years, using clear aligners, I

Enjoy and have fun Making the MOVE!

Stephane Reinhardt, DMD

© 2023 The CLEAR Institute Inc. All rights reserved

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #1: P.C.S.

Too often, we start by giving our patients the

We should always start with explaining the

The solution is to move the teeth and bring

Clear aligners are the tools we use, and they

Example: "Mrs. Smith, your teeth are not

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #2: GIVE OPTIONS

It's important to use the right words. We give

The first option is simple: it's always "Do

The second option is the ideal treatment that

The third option for this patient would be to

Everything is possible. The important is to

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #3: UNDERSTAND WHAT YOU SEE

It is important to make the difference

There is a difference between both. You know

When you look at a virtual setup, even if you

It is sometimes counterintuitive, and you may

Don't let the software decide for you!

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #4: UNDERSTAND MECHANICS

We sometimes hear: "We will do an Invisalign

To understand orthodontics, to understand

Tip, torque, center of resistance, center of

It is not always easy to master these

The only way to ensure you will never have

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #5: VERTICAL MEETS HORIZONTAL

For example, if you want to extrude a tooth,

To be efficient, we need a surface where we

This is where we need to add attachments.

The best way to remember it is to have the

In other words, a vertical force will need a

© 2023 The CLEAR Institute Inc. All rights reserved

TIP # 6: WHEN IN DOUBT...

"Should I put an attachment on this tooth?"

When in doubt, put an attachment. You will

On the other hand, if you remove

When the software puts an attachment on a

Don't listen to your patients who want to

What is the limit to the number of

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #7: SIZE MATTERS

Since they are pushing, the surface where the

One of the ways we can help movement

Since the force will be applied to these

Why would you put a 3mm attachment on a

If you work with Invisalign, you can use

When choosing OA, go into your clinical

© 2023 The CLEAR Institute Inc. All rights reserved

TIP #8: POSITION MATTERS

Another thing I constantly repeat when I

Take an aligner in your hand, no matter the