How to review a clear aligner setup before approval

1. Define the treatment objectives first

Do not start with the animation. Start by stating what the plan is intended to correct. Record the desired arch-form, sagittal, vertical and transverse changes, the target midlines and occlusal relationships. Document relevant constraints, including periodontal status, restorations, missing teeth, implants, impacted teeth, treatment timing and whether the patient can comply with elastics or other auxiliaries.

The clinician's instructions should be specific. “Align the teeth” is less useful than defining acceptable expansion, space preservation, incisor position and movements that should be avoided. Clear objectives reduce the chance of approving a technically polished setup that solves the wrong clinical problem.

2. Check records and remove patient identifiers

• high-quality STL files or intraoral scans of both arches;
• a reliable bite registration without mandibular displacement;
• intraoral and facial photographs in comparable views;
• radiographic information when clinically indicated;
• diagnosis, treatment objectives, questions and limitations;
• current information on restorations, implants and planned procedures.

Before sending a case to an external reviewer or planning provider, remove the patient's name, date of birth and other identifying information. Use an internal case number and share only the information necessary for professional assessment.

3. Compare the initial and proposed occlusion

Assess baseline contacts, arch form, curve of Spee, overjet, overbite, crossbite and potential functional interferences. At the final stage, check whether the proposed result depends on unwanted incisor tipping or excessive expansion. Contacts should not merely look symmetrical in a rendering; they must be compatible with crown morphology, planned extrusion and realistic aligner seating.

Inspect the model from all directions and review each arch separately. Compare digital measurements with photographs and diagnostic findings. A virtual bite alone cannot show soft-tissue conditions or functional factors.

4. Review staging and movement magnitude

Move through the simulation stage by stage. Identify moments when several demanding movements are attempted at once, or when anchorage units move before adequate space has been created. Large rotations, extrusion, bodily movement, torque control, space closure and distalisation deserve particular attention.

The sequence should express the intended biomechanics: create space and establish anchorage before asking for controlled movement. For complex corrections, decide which movements should be separated, where overcorrection may be justified and when a clinical reassessment should occur.

5. Consider roots and alveolar boundaries

Crowns may appear aligned while roots remain unfavourably positioned. Review initial root angulation using the diagnostic information available. CBCT should only be used when clinically indicated and justified by radiation-protection principles. When volumetric data are available, compare planned movement with alveolar boundaries and other anatomic risk areas.

Flag areas where virtual expansion, proclination, torque or movement through a defect may require a modified objective or closer clinical monitoring. A software model is not a substitute for biological assessment.

6. Verify IPR and space creation

Add up planned IPR by segment and confirm that the resulting space serves the stated objective. Check the sequence of reduction, access to contact points, crown morphology and whether the procedure can be carried out safely. A space shortage should not be automatically hidden by excessive proclination or expansion without an explicit clinical decision.

The plan should state where and when IPR is required. During treatment, measure the amount achieved because actual reduction can differ from the digital prescription.

7. Assess attachments and auxiliaries

For every attachment, ask three questions: which movement does it support, can the aligner engage its active surface reliably, and can it be bonded predictably in that position? Look for occlusal conflicts, proximity to the gingival margin and practical limitations of the transfer template.

If elastics, buttons, cut-outs, pontics or bite ramps are proposed, they should match the anchorage strategy and treatment sequence. More attachments do not automatically make a plan more predictable.

8. Analyse anchorage and biomechanics

Identify the active and reactive units. During distalisation, space closure or midline correction, establish which teeth should remain stable and how this will be achieved. Consider side effects such as torque loss, mesial drift of the anchorage segment, bite deepening, contact opening or tipping instead of bodily movement.

A sound setup can be explained in biomechanical terms. If the sequence cannot be connected to a coherent force system, the plan needs further discussion.

9. Plan tracking checks and refinements

Mark movements with a greater risk of deviation between the digital setup and the clinical result. Define monitoring points for aligner seating, contact maintenance, periodontal status, completed IPR and elastic wear. A refinement is not simply an automatic continuation: establish why tracking was lost before rescanning and adjust the mechanics accordingly.

10. Final questions before approval