Aligner Wear Schedule
A patient asks, "How long do I wear my aligners?"
There are three components to the question:
Wear Cycle - How many days to I wear a step before moving to the next step?
Daily Wear - How long do I need to wear my aligners each day?
Plan length - How many months before I am finished?
IMPORTANT: A patient’s compliance affects every component of his aligner wear schedule and will significantly influence treatment time, cost, and results.
What is the Aligner Wear Cycle?
Defined: The aligner wear schedule is how long your patient will wear each set of aligners before progressing to the next set.
While Orthosnap generally recommends 7-day cycles, you and your patient will need to adapt to their circumstances. There are several factors that affect the choice of wear cycle:
Clinical factors - Perio condition, age, and other osteo-related factors that may affect the speed of the osteogenesis.
Patient compliance - If the patient does not wear aligners for 22 hours a day, they will likely require more days in the wear cycle to accomplish the movement.
The Treatment Plan - Orthosnap treatment plans use anchorage and staged movements so the same tooth is not moved every step. Often after an active movement on a specific tooth, the next two aligners are retaining that tooth without movement and instead move other teeth, which allows for shorter wear cycles since the osteogenesis process takes place over several wear cycles (so for example, a wear cycle of 5 days but with 3 aligners for the same movement, means a total of 15 days is given to accomplish the process.
Ultimately, you, as the treating doctor, decide the aligner schedule and include it as part of your prescription.
How many aligners should I give a patient at their appointments?
Determining how many aligners you give patients at one time is part math and part discernment.
For instance, if you plan to see your patient every five weeks and you have them on a schedule to change aligners every week, you will want to give them five aligners.
5 weeks / 1-week cycles = 5 aligners
That’s math.
The discernment part comes into play when determining your patient’s level of compliance. For instance, if patients won’t wear their aligners at least 22 hours a day, they will not be ready for the next aligner on schedule. This could mean the distribution of fewer aligners—especially if you decide to bring your patient into the office more often. Fewer aligners and appointments scheduled closer together will help you keep an eye on progress and let your patient know if total treatment time is extended due to non-compliance with the wear schedule.
Daily Wear
Aligners should be worn for 20-22 hours every day.
Here is a video that can explain to patients why this is the case, and why not wearing aligners for more than four hours, even for one day, can impact the progress of the bone remodeling process.
It takes approximately 48-72 hours for osteoclastic activity to begin. Therefore, the most movement occurs in the first few days of wearing a fresh aligner. However, the lack of force on the teeth for as little as four hours can stop the process. When the process stops, it can take another few days for the process to begin again. If you can explain this to your patient, you may get better compliance. In short, if they don’t follow the wear schedule, the treatment plan will take longer.
Plan Length
To determine a patient’s plan length, the first consideration is how much correction is needed - i.e. how many steps are needed. The more complex the treatment plan with more movement needed, the more steps. On the flip side, if your patient only needs minor adjustments, overall treatment will be shorter.
Each aligner step is designed to move specific teeth to a specific location as your patient progresses through a series of aligners. Over time, the teeth will reach their ideal position. The number of aligners needed to achieve the ideal results varies, which affects total treatment time.
The estimated number of steps is provided to you in your Treatment Plan, and after discussion and approval, becomes the basis for guiding the overall plan length.
Patient Compliance is Key
To achieve optimum results in the least amount of time, patients must wear their aligners at least 22 hours a day every day. Deviations from this can greatly impact the outcome and patient satisfaction. Therefore, you should stress to patients the importance of thinking about why they remove aligners during the day, such as with eating and oral hygiene. Reasons like “they’re uncomfortable” or “I can’t talk right” aren’t good enough. The patient should understand the trade off they’re making when removing the aligners.
Given osteoclastic activity, if your patient chooses to keep the aligners out for more than a couple of hours at a time, things will slow down tremendously. Since most of the movement occurs in the first few days, if your patient has a significant reason that would keep the aligners out for more than four hours, such as an upcoming surgery, you can work with them. For instance, consider holding off moving to a new set of aligners until after the surgery. This can reduce the overall treatment time in the end, as keeping the aligners out for extended periods of time is not as crucial at the end of a step as it is at the beginning.
To make sure patients stick to their wear schedule, we provide a Verification Key™ aligner. This clearly marked key allows you to assess compliance, and it is normally included after the 8th step.
We also provide a service called Remote Patient Monitoring, which has many great advantages for patient compliance, convenience, and chair time savings. You can learn more about it here.
Once I set an aligner wear schedule, can I change it?
If you need to make any changes to the aligner wear schedule, please contact our support personnel at support@orthosnap.com.