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5 Proven Strategies to Improve Clear Aligner Outcomes by Dr. Paola Leone

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Categories: Orthodontics;
5 Proven Strategies to Improve Clear Aligner Outcomes Reduce refinements, enhance treatment predictability and boost aligner case efficiency

by Dr. Paola Leone

Our Invisalign representative asked about our low refinement rate. Over the past years, patients at Leone and Vaughn Orthodontics averaged just 0.54 refinement scans each—more than half required no refinements, 40% needed one additional series of aligners, and less than 10% needed two or more additional aligner sets. Here’s the approach that helped us reduce refinements, without compromising final results.


1. Set realistic treatment goals
When setting treatment objectives, I balance patient expectations and treatment goals with the limitations of each case. This requires a clear understanding of each patient’s treatment objectives and their feasibility.


2. Adjust for compliance
Determining compliance is critical, especially with teens. For example, if I am unsure how compliant the patient will be, I test them with a pre-Invisalign phase, a carrier distalizer. If the patient responds well, we will transition to Invisalign. However, if the patient demonstrates inadequate elastic compliance, I discuss fixed appliances, or we set realistic Class II correction goals in our ClinCheck planning.

I always start with a two-week aligner rotation. At the first follow-up visit, I decide, based on compliance and movement difficulty, whether to continue or to reduce it to every 10 days.

I rarely instruct patients to switch every seven days unless they also use red light therapy or in mixed dentition.


3. Limit treatment time
I aim to keep aligner treatments to 14 months or less. Beyond that, patients often tire of the routine, and compliance tends to drop once the front teeth are straight. For cases requiring 40 to 60 or more aligners, where complex and challenging movements are planned, I consider using fixed appliances sequentially or in tandem with the aligners. I also strongly encourage red light therapy.

Red light therapy helps significantly accelerate the rate of tooth movement while at the same time reducing pain and discomfort.


4. Invest time in detailed treatment planning
Be detail-oriented and leave nothing to chance.

I tailor the movement of each tooth. I decide what to move, when and what forces to use in each case. I identify complex movements and remove any unnecessary or unwanted movements. I incorporate “escape” mechanics for more complicated movements such as rotation or extrusion, incorporating buttons for de-rotation and extrusive movements in the last few aligners or the overcorrection aligners.

Movements staging
I identify complex movements and always ensure sufficient clearance for the teeth, intra-arch and inter-arches. I also make sure there is enough plastic to surround the teeth. The plastic must be free to move the tooth, and the tooth must have the clearance to move within the plastic.

Is it realistic?
I adjust the plan based on my experience, especially if a predicted movement is unlikely to occur within the specified time frame or using plastic alone. I will adjust velocity and add adjunctive mechanics such as TAD, elastics or segmental fixed appliances.

I am not an Invisalign provider; I am an orthodontist using Invisalign and any tool I have in my toolbox to make my cases successful.

Overcorrection
I overcorrect any complex movements to ensure I go beyond the “virtual” ideal to reach the “clinical” ideal.


5. Leverage red light therapy to increase predictability
Red light therapy improves the efficiency and predictability of challenging tooth movements. The light penetrates the gingiva mucosa and bone to stimulate osteoclasts and osteoblasts cellular activity increasing bone and soft tissue remodeling. Clinical studies show it accelerates the healing process, reduces inflammation and patient discomfort, and improves the expression of movement. This has proven true in my practice over the past six years of using red light therapy.

Since introducing red light therapy (we use the OrthoPulse device), we have shorter aligner change intervals, we see a significant reduction of the overall treatment time and increase in aligner tracking even in complex tooth movements. It has also significantly reduced our refinement rates and contributed to better outcomes. I offer it to all my patients, but for complicated cases, it is non-negotiable.


Case #1: 28-year-old patient
Treatment time: 10 months.
Number of aligners: 39 U/L with 5–7-day aligner change. This case was completed without refinements.
Clear Aligner Strategies
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Clear Aligner Strategies
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Clear Aligner Strategies
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Clear Aligner Strategies
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Case #2: 28-year-old patient
Class I, severe UL2 rotation (75 degrees) and deep bite.
Treatment time: 14 months.
Number of aligners: 53 U/35 L. No refinement needed.
Clear Aligner Strategies
Fig. 7
Clear Aligner Strategies
Fig. 8
Clear Aligner Strategies
Fig. 9
Clear Aligner Strategies
Fig. 10
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Fig. 11
Clear Aligner Strategies
Fig. 12
Clear Aligner Strategies
Fig. 13

Case #3: 30-year-old patient
Class II deep bite.
Treatment time: 15 months.
Number of aligners: #57 U/L, plus refinement. Aligners #12U/7L. This case was completed with one refinement.
Clear Aligner Strategies
Fig. 14
Clear Aligner Strategies
Fig. 15
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Fig. 16

Conclusion
Achieving low Invisalign refinement rates is possible through realistic treatment goals, early compliance assessment and strategic planning movements. Incorporating red light therapy further enhances the predictability and speed of challenging cases. This approach improves practice efficiency and the patient experience by shortening treatment times and achieving optimal outcomes.

Author Bio
Dr. Paola Leone Dr. Paola Leone is a board-certified orthodontist who shares three practices in the Bellevue, Washington, region with her orthodontist husband, Dr. Gregory Vaughn. She taught at the University of Washington for 20 years and lectures nationally and internationally on achieving predictable aligner treatment.



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