Frequently Asked Questions

We’ve created a list of most commonly asked questions and best practice guidelines for submitting cases to EZ-Align for Clear Aligners. Please use the information below to answer any questions you may have.

General Questions

IS YOUR PATIENT A GOOD CANDIDATE?
  • Some examples of good candidates for your first clear aligner treatment cases are:
    • Ortho relapses
    • Minor anterior spaces
    • Minor anterior crowding
    • Single arch treatment with minor goals
    • Minor alignment of the upper and lower anterior teeth
  • If you already have some experience with clear aligner cases, some examples of good candidates include:
    • Moderate anterior spacing
    • Moderate anterior crowding
    • Overjet correction
    • Overbite correction
    • Class II or Class III cases in conjunction with the use of elastics
  • The following examples are suggested only with considerable education and experience as they can be difficult or impossible to treat with clear aligner therapy:
    • Any type of difficult or complex movement
    • Patients without fully erupted second molars
    • Patients with implants or other dental prosthetics
    • Patients with short clinical crowns
    • Patients with multiple missing teeth
    • Severe bruxism cases
    • Patients with poor oral hygiene or periodontal disease
    • Patients with TMJ issues
  • Occasionally there are cases we will reject as candidates for EZ-Align. If patient is adamant about clear aligners, we will generally suggest another appliance or traditional ortho prior to aligners. Here are some examples:
    • Severe open bite cases that the patient wishes to close
    • Patients trying to correct significant posterior crossbite
    • Correcting skeletal Class II or Class III occlusion
    • Any major distalization of the posterior teeth
    • Patients with compliance issues
What if the patient only needs/wants movement on one arch?
  • We offer individual aligners for movement of a single arch.
  • We can modify one of our systems to utilize all but one of the aligners on the arch requiring movement and fabricate a either a retainer or a throw-away aligner for the opposing arch
What if the patient has a lot of crowding?
  • We offer our EZ-Plus system.
    • This system starts with an upper and lower clear lateral development appliance called the EZ-X to be used prior to clear aligners. The EZ-X https://ezalign.com/doctors/ez-x/ can expand up to 5mm.
    • After expansion is complete, submit new scans, models or impressions and the lab will fabricate the aligners.
    • The EZ-Plus system can be added to any of our systems above. Contact the lab for pricing.
Will the patient need attachments?
  • We understand not all Doctors or patients prefer the use of attachments, however we will suggest them for all cases requiring more than 0.5mm of intrusion or extrusion.
  • If the case presents curve of spee issues that we are to correct, we will suggest attachments to extrude the posterior or intrude the anterior.
  • If the case presents heavy rotations, torque or tip issues, attachments will also be suggested.
What if I or the patient wishes to have no IPR?
  • Please note, there are certain case limitations which 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 the EZ-X appliance or other expansion appliances prior to clear aligner therapy.
Patient has a Class II or Class III bite relationship and trying to attain Class I.
  • We offer class II and class III elastics to be used in conjunction with our clear aligners.
  • We do take into account the patient’s age when treatment planning for elastics cases.
  • We offer both cutouts for buttons or precision cuts/slots cut into the aligners for the elastics.
  • We offer arch correction simulation, available to view if a treatment review is requested. Our highest trained technicians will digitally articulate the case to the molar positioning requested so that we can align the anterior and posterior teeth to the bite relationship that will be attained through compliant elastic wear.
Patient is missing a tooth, what options are available until aligner treatment is completed?
  • Pontics are available to be placed in the aligner (please make sure to note the shade on the RX)
  • Tooth shaped voids for composite are also available. We only offer limited standard shades of pontics, if patient requests a non-standard shade or if you would prefer composite the lab will create a tooth shaped void in the aligner for you to fill in office. (Please make sure to note on the RX that you would like a composite void for the missing tooth)
Do I need to order retainers?
  • EZ-Align clear aligner material is contraindicated for retention purposes. Each aligner is to be worn for a maximum of 4 weeks only.
  • If the case is complex, it is best to wait until after treatment is complete to see if any refinement is needed before ordering retainers.
  • If you do not think the case will warrant refinement, you can request for the lab to make the final aligner with retainer material or order retainers in addition to the aligners on the RX.
  • We offer many cost saving options for retention. Please contact the lab for details.
What all do I need to send in for EZ-Align?
  • A completed EZ-Align RX outlining your treatment objectives. If you are unsure of what system to choose, you can check the box for “lab discretion” or write in the comments for us to contact you with an evaluation or to send you a treatment review.
  • Models, impressions, or digital scans.
  • A physical bite if sending models or impressions
  • A scan bite or occlusion scan if sending digitally
  • Photos are not required but are helpful especially with midline shifts, etc
  • Panoramic radiographs are also not required but are helpful for us to determine root positioning, to determine if a tooth is an implant or prosthesis, etc
What types of impressions does DynaFlex accept?
  • PVS
  • VPS
  • 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.
Can you give me tips for taking impressions?
  • 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)
New impressions will be required for the following reasons:
  • 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.
SENDING IN PHYSICAL IMPRESSIONS
  • Please make sure to thoroughly check the impressions before sending to ensure they are free from any defects or deformities.
  • Fill out an EZ-Align RX using DynaFusion or Traditional Prescriptions
  • Ensure you have filled out the RX thoroughly with your account information as well as your treatment objectives.
  • If you do not already have DynaFlex boxes, you may cut the business reply label from the upper right hand corner of the RX or download one here and place on any box to send in your case.
  • It is not necessary to wrap the PVS impressions in wet paper towels, you can simply place them in the box with the filled out RX and ship them directly to the lab.
Sending In Physical Models
  • Please make sure to thoroughly check the models before sending to ensure they are free from any defects or deformities. If there is excess stone (particularly around the CEJ), broken teeth, double impression of certain teeth, etc the models will be rejected and we will request new ones before fabrication.
  • Place the stone models in a foam pouch if you have one available to you, otherwise make sure to wrap the models well with bubble wrap or another form of protection. Many models are damaged in route to the lab so you will want to take extra care to make sure they are protected.
  • Fill out an EZ-Align RX using DynaFusion or Traditional Prescriptions
  • Ensure you have filled out the RX thoroughly with your account information as well as your treatment objectives.
  • If you do not already have DynaFlex boxes, you may cut the business reply label from the upper right hand corner of the RX or download one here and place on any box to send in your case.
Benefits of digital or intraoral scans:
  • More comfortable than physical impressions
  • No shipping costs or hassles
  • 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
Tips for taking intraoral scans:
  • 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.
SUBMITTING A CASE DIGITALLY
  • If your scanner is set up to automatically send your .stl files to DynaFlex, you will just need to make sure to email your completed RX to rx@dynaflex.com
  • If you 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 with an Egnyte account to submit your cases or you can email your .stl files and completed RX to rx@dynaflex.com
  • It is IMPERATIVE to always submit an RX or the scans will not be pulled from the database
DELIVERY OF THE ALIGNERS
  • 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
    • 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
What are considered fit issues?
  • 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.
  •  
What are some solutions to try for fit issues?
  • 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.
  •  
TRACKING ISSUES
  • What are tracking issues?
    • Tracking describes how EZ-Align clear aligners move the patients 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.
  •  
RESIDUAL SPACING
  • 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 (included with the Unlimited system, small fee for all other systems) 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.

How To Choose What System Works Best For Your Patient

We offer the following systems: 

Unlimited
  • Unlimited (Unlimited number of upper aligners and lower aligners) to be used for complex tooth movement. This system also includes 6 years of unlimited refinement aligners, replacement aligners, and retainers.
Terrific 20
  • Terrific 20 (20 upper aligners and 20 lower aligners) to be used for intermediate to complex tooth movement. This system can be split up differently if needed to utilize more of the aligners on a particular arch. If case presents crowding, this system is limited to 2mm of expansion total per arch.
Perfect 10
  • Perfect 10 (10 upper aligners and 10 lower aligners) to be used for minor to intermediate tooth movement. This system can be split up differently if needed to utilize more of the aligners on a particular arch. If case presents crowding, this system is limited to 1mm of expansion total per arch.
Fast 5
  • Fast 5 (5 upper aligners and 5 lower aligners) to be used for minor tooth movement of the anterior teeth. This system can be split up differently if needed to utilize more of the aligners on a particular arch.

**PLEASE NOTE, ALL SYSTEMS REQUIRE ALIGNERS FOR BOTH ARCHES.

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